Information Collection

Household Screening

IC 43643 under ICR 202212-0930-004 · OMB 0930-0110.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0110 can be found here:

Documents and Forms

Document Name Document Type
Form 2022_NSDUH_Screene Household Screening Form and Instruction
2022_NSDUH_Screene 2022_NSDUH_Screener_Specs 2022_NSDUH_Screener_Specs.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Household Screening	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	2022_NSDUH_Screener_Specs	2022_NSDUH_Screener_Specs	2022_NSDUH_Screener_Specs.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Alcohol, Drug Abuse, and Mental Health Epidemiologic Data (HHS/SAMHSA/OA)	FR Citation: 84 FR 27341

Number of Respondents: 168,673	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	168,673	168,673
Annual IC Time Burden (Hours)	14,000	14,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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