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Clinical Interview
National Mental Health Study (NMHS) Field Test
OMB: 0930-0380
IC ID: 227429
OMB.report
HHS/SAMHSA
OMB 0930-0380
ICR 201707-0930-003
IC 227429
( )
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
Federal Enterprise Architecture Business Reference Module
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
150
0
150
0
0
0
Annual IC Time Burden (Hours)
150
0
150
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.