Information Collection

National Institute of Mental Health (NIMH) Brochures and Fact Sheets Customer Satisfaction Survey

IC 267330 under ICR 202103-0925-003 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Survey National Institute of Mental Health (NIMH) Brochures and Fact Sheets Customer Satisfaction Survey	Form
1 Survey Collection Instrument_NIMH Survey About Brochures and Fact Sheets Screenshots_04.23.24.pdf	Form
0925-0648 Template exp.6.2024_SWPD 2024 Brochures and Fact sheets survey.docx Template	IC Document
Recruitment Materials_NIMH Brochures and Fact Sheets Survey Message.png Recruitment Materials	IC Document

IC Title:

National Institute of Mental Health (NIMH) Brochures and Fact Sheets Customer Satisfaction Survey

Agency IC Tracking Number:

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	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,900

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	2,900	2,900
Annual IC Time Burden (Hours)	242	242
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Template		04/29/2024
Recruitment Materials		04/29/2024

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

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