Information Collection

Clinical Interview

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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.