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Locator Survey 2021
2019-22 National Mental Health Services Survey (N-MHSS)
OMB: 0930-0119
IC ID: 209518
OMB.report
HHS/SAMHSA
OMB 0930-0119
ICR 201910-0930-002
IC 209518
( )
Documents and Forms
Document Name
Document Type
Form Locator Survey
Locator Survey 2021
Form and Instruction
Locator Survey Locator Survey
Attachment A.2_2021 N-MHSS-Locator Survey Paper Questionnaire_also for Between-Survey Update_9_20_19.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Locator Survey 2021
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
Locator Survey
Locator Survey
Attachment A.2_2021 N-MHSS-Locator Survey Paper Questionnaire_also for Between-Survey Update_9_20_19.docx
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:
17,000
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
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
17,000
0
0
0
0
17,000
Annual IC Time Burden (Hours)
7,140
0
2,890
0
0
4,250
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.