Information Collection

Facilities Universe in 2020 and 2022

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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	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 %

table that charts list of burden
	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

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.