Information Collection

Facilities Universe in 2020 and 2022

IC 7528 under ICR 201910-0930-002 · OMB 0930-0119.

Documents and Forms

Document Name Document Type
Form Full Scale - Paper Facilities Universe in 2020 and 2022 Form and Instruction
Full Scale - Paper Full Scale - Paper Attachment A.1_2020 N-MHSS (Full-Scale) Paper Questionnaire_9_19_19.docx Form and Instruction
Full Scale - CATI Full Scale - CATI Attachment A.5_2020 N-MHSS CATI Questionnaire_8-8-2019.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Facilities Universe in 2020 and 2022	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	Full Scale - Paper	Full Scale - Paper	Attachment A.1_2020 N-MHSS (Full-Scale) Paper Questionnaire_9_19_19.docx		Yes	Yes	Fillable Fileable
Form and Instruction	Full Scale - CATI	Full Scale - CATI	Attachment A.5_2020 N-MHSS CATI Questionnaire_8-8-2019.docx		Yes	Yes	Fillable Fileable

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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	17,000	0	17,000
Annual IC Time Burden (Hours)	12,750	7,990	4,760
Annual IC Cost Burden (Dollars)	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.