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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.