I-TF Facility Registration Application Form

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

Documents and Forms

Document Name Document Type
Form I-TF Facility Regi I-TF Facility Registration Application Form Form and Instruction
I-TF Facility Regi I-TF Facility Registration Application Form Attachment F. I-TF Facility Registration Application Form final.pdf Form and Instruction
I-TF Facility Regi I-TF Facility Registration Application Form Attachment F. I-TF Facility Registration Application Form final.pdf Form and Instruction
Attachment F1. I-TF Facility Registration Application Form - Track Changes final.pdf Attachment F1. I-TF Facility Registration Application Form - Track Changes IC Document
Attachment F1. I-TF Facility Registration Application Form - Track Changes final.pdf Attachment F1. I-TF Facility Registration Application Form - Track Changes IC Document

Information Collection (IC) Details

IC Title:	I-TF Facility Registration Application Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	I-TF Facility Registration Application Form	I-TF Facility Registration Application Form	Attachment F. I-TF Facility Registration Application Form final.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	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	Previously Approved
Annual Number of Responses for this IC	1,500	700	800
Annual IC Time Burden (Hours)	120	56	64
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment F1. I-TF Facility Registration Application Form - Track Changes	Attachment F1. I-TF Facility Registration Application Form - Track Changes final.pdf	11/30/2023

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