Information Collection

Clinical Interview

IC 227429 under ICR 201707-0930-003 · OMB 0930-0380.

Documents and Forms

Document Name Document Type
Form CRS Adult and Adol Clinical Interview Form and Instruction
CRS Adult and Adol CRS Adult and Adolescents Questioonaire NMHS OMB_PDF 04.pdf Form and Instruction
NMHS OMB_PDF 11.pdf CRS Adult and Adolescents Materials IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Clinical Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CRS Adult and Adolescents Questioonaire	CRS Adult and Adolescents Questioonaire	NMHS OMB_PDF 04.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CRS Adult and Adolescents Materials	NMHS OMB_PDF 11.pdf	07/10/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.