Information Collection

2021 Survey of Behavioral Health Workforce Employers

IC 246778 under ICR 202104-0930-001 · OMB 0930-0387.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0387 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form EmployerSurvey_Que 2021 Survey of Behavioral Health Workforce Employers	Form and Instruction
EmployerSurvey_Que EmployerSurvey_Questionaire 09A EmployerSurvey_Questionnaire.docx	Form and Instruction
Employer Survey Qu Employer Survey Questionnaire 7/21/2021 Survey Employer_Clean_OMB_FINAL.docx	Form and Instruction
08A EmployerSurvey_ICF.docx EmployerSurvey_ICF	IC Document
08A EmployerSurvey_ICF.docx EmployerSurvey_ICF	IC Document

IC Title:

2021 Survey of Behavioral Health Workforce Employers

Agency IC Tracking Number:

Is this a Common Form? No

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 and Instruction	Employer Survey Questionnaire 7/21/2021	Employer Survey Questionnaire 7/21/2021	Survey Employer_Clean_OMB_FINAL.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 2021 Survey of Behavioral Health Workforce Employers

FR Citation: 75 FR 28264

Number of Respondents: 2,800

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
Annual Number of Responses for this IC	2,800	2,800
Annual IC Time Burden (Hours)	700	700
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
EmployerSurvey_ICF	08A EmployerSurvey_ICF.docx	04/13/2021

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