2021 Survey of Behavioral Health Workforce Providers

2021 Behavioral Health Workforce Surveys

⚠️ Notice: This information collection may be referencing outdated material.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 ProviderSurvey_Que 2021 Survey of Behavioral Health Workforce Providers Form and Instruction
ProviderSurvey_Que ProviderSurvey_Questionaire 09B ProviderSurvey_Questionnaire.docx Form and Instruction
Provider Survey Qu Provider Survey Questionnaire 7/21/2021 Survey Provider_Clean_OMB_FINAL.docx Form and Instruction
08B ProviderSurvey_ICF.docx ProviderSurvey_ICF IC Document
08B ProviderSurvey_ICF.docx ProviderSurvey_ICF IC Document

Information Collection (IC) Details

IC Title:	2021 Survey of Behavioral Health Workforce Providers	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	Provider Survey Questionnaire 7/21/2021	Provider Survey Questionnaire 7/21/2021	Survey Provider_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 Providers	FR Citation: 75 FR 28264

Number of Respondents: 5,000	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
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	1,250	1,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ProviderSurvey_ICF	08B ProviderSurvey_ICF.docx	04/13/2021

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