OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

N-SUMHSS (either SU or MH)

IC 243268 under ICR 202311-0930-001 · OMB 0930-0386.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

N-SUMHSS (either SU or MH)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction N-SUMHSS Questionnaire N-SUMHSS Questionnaire Attachment A. N-SUMHSS Questionnaire final _202308.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

32,000 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 32,000 0 0 0 0 32,000
Annual IC Time Burden (Hours) 26,560 0 5,120 0 0 21,440
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
N-SUMHSS Questionnaire - Tracked Attachment A1. N-SUMHSS Questionnaire - Track Changes final _202308.docx 11/30/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.