Information Collection Request

National Substance Use and Mental Health Services Survey (N-SUMHSS)

ICR 202311-0930-001 · OMB 0930-0386 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form N-SUMHSS EHR Suppl N-SUMHSS EHR Supplement Form and Instruction New Repair queued
Form N-SUMHSS VA Supple N-SUMHSS VA Supplement Form and Instruction New Repair queued
Form N-SUMHSS Questionn N-SUMHSS (both SU and MH) Form and Instruction Modified Repair queued
Form N-SUMHSS Questionn N-SUMHSS (either SU or MH) Form and Instruction Modified Repair queued
Form N-SUMHSS Between C N-SUMHSS BC Form and Instruction Modified Repair queued
Form Augmentation Scree Augmentation Screener Form and Instruction Modified Repair queued
Form I-TF Facility Regi I-TF Facility Registration Application Form Form and Instruction Modified Repair queued
Form I-TF Online State I-TF Online State Add Update Form Form and Instruction Modified Repair queued
Attachment 11. N-SUMHSS Web Survey Prototype final.pdf Supplementary Document Uploaded 2023-11-30 Repair queued
Attachment 10. N-SUMHSS CATI Interviewer Instructions final.pdf Supplementary Document Uploaded 2023-11-30 Repair queued
Attachment 9. N-SUMHSS Information Website final.docx Supplementary Document Uploaded 2023-11-30 Missing upstream
Attachment 8. N-SUMHSS Reminder Letter final.pdf Supplementary Document Uploaded 2023-11-30 Repair queued
Attachment 7. N-SUMHSS Thank-you Letter final.pdf Supplementary Document Uploaded 2023-11-30 Repair queued
Attachment 6. N-SUMHSS Client Counts Worksheet final.pdf Supplementary Document Uploaded 2023-11-30 Repair queued
Attachment 5. N-SUMHSS FAQs final.pdf Supplementary Document Uploaded 2023-11-30 Repair queued
Attachment 4. N-SUMHSS Web Access Instructions final.pdf Supplementary Document Uploaded 2023-11-30 Repair queued
Attachment 3. Sample State Invitation Letter final.pdf Supplementary Document Uploaded 2023-11-30 Repair queued
Attachment 2.3 N-SUMHSS Third Cover Letter final.pdf Supplementary Document Uploaded 2023-11-30 Repair queued
Attachment 2.2 N-SUMHSS Second Cover Letter final.pdf Supplementary Document Uploaded 2023-11-30 Repair queued
Attachment 2.1 N-SUMHSS Cover Letter final.pdf Supplementary Document Uploaded 2023-11-30 Repair queued
Attachment 1.2 N-SUMHSS Between Cycle Advance Letter final.pdf Supplementary Document Uploaded 2023-11-30 Missing upstream
Attachment 1.1 N-SUMHSS Advance Letter final.pdf Supplementary Document Uploaded 2023-11-30 Repair queued
4. Supporting Statement A N-SUMHSS 2023 final _202308.docx Supporting Statement A Uploaded 2023-11-30 Repair queued
5. Supporting Statement B N-SUMHSS 2023_final _202308.docx Supporting Statement B Uploaded 2023-11-30 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
263749 N-SUMHSS EHR Supplement Form and Instruction New
263748 N-SUMHSS VA Supplement Form and Instruction New
243269 N-SUMHSS (both SU and MH) Form and Instruction Modified
243268 N-SUMHSS (either SU or MH) Form and Instruction Modified
243267 N-SUMHSS BC Form and Instruction Modified
243266 Augmentation Screener Form and Instruction Modified
243265 I-TF Facility Registration Application Form Form and Instruction Modified
243263 I-TF Online State Add Update Form Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 03/31/2024
82,150 44,300
39,033 28,109
0 0





Reginfo record details
8
table that charts list of burden
IC Title Form No. Form Name
Augmentation Screener Augmentation Screener Questionnaire Augmentation Screener Questionnaire
I-TF Facility Registration Application Form I-TF Facility Registration Application Form I-TF Facility Registration Application Form
I-TF Online State Add Update Form I-TF Online State Add Update Form I-TF Online State Add Update Form
N-SUMHSS (both SU and MH) N-SUMHSS Questionnaire N-SUMHSS Questionnaire
N-SUMHSS (either SU or MH) N-SUMHSS Questionnaire N-SUMHSS Questionnaire
N-SUMHSS BC N-SUMHSS Between Cycle Questionnaire N-SUMHSS Between Cycle Questionnaire
N-SUMHSS EHR Supplement N-SUMHSS EHR Supplement N-SUMHSS EHR Supplement
N-SUMHSS VA Supplement N-SUMHSS VA Supplement N-SUMHSS VA Supplement

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 82,150 44,300 0 37,850 0 0
Annual Time Burden (Hours) 39,033 28,109 0 10,924 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No