Information Collection

2021 Survey of Behavioral Health Workforce Employers

IC 246778 under ICR 202110-0930-003 · OMB 0930-0387.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Employer Survey Qu 2021 Survey of Behavioral Health Workforce Employers	Form and Instruction
Form Employer Survey Qu Employer Survey Questionnaire 7/21/2021 2021 Survey of Behavioral Health Workforce Employers	Form and Instruction
Employer Survey Qu Employer Survey Questionnaire 7/21/2021 Survey Employer_Clean_OMB_FINAL.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:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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				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	Previously Approved
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		04/13/2021

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

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