Information Collection

Interview

IC 195358 under ICR 201810-0930-004 · OMB 0930-0110.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0110 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CAI Questionnaire Interview	Form and Instruction
CAI Questionnaire CAI Questionnaire 2019 NSDUH_PDF 2_attachment B_2019_CAI_Questionnaire_5.29.18.pdf	Form and Instruction
CAI Questionnaire CAI Questionnaire 2019_CAIQuestionnaire_FINAL_Del6_Kratom.docx	Form and Instruction

IC Title:

Interview

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	CAI Questionnaire	CAI Questionnaire	2019 NSDUH_PDF 2_attachment B_2019_CAI_Questionnaire_5.29.18.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CAI Questionnaire	CAI Questionnaire	2019_CAIQuestionnaire_FINAL_Del6_Kratom.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Alcohol, Drug Abuse, and Mental Health Epidemiologic Data (HHS/SAMHSA/OA)

FR Citation: 75 FR 28264

Number of Respondents: 67,507

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	Previously Approved
Annual Number of Responses for this IC	67,507	67,507
Annual IC Time Burden (Hours)	67,507	67,507
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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