Information Collection

Mental Health Surveys

IC 265929 under ICR 202402-1405-001 · OMB 1405-0193.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Survey Mental Health Surveys	Form and Instruction
Survey Mental Health Surveys 1. Questions 1 & 2.pdf	Form and Instruction
Survey Mental Health Surveys 2. Question 3.pdf	Form and Instruction
Survey Mental Health Surveys 3. Question 4 - Question about RMOP Service.pdf	Form and Instruction
Survey Mental Health Surveys 4. Question 5 & 6 (9 questions total) - Questions about RMOP Service - Counseling and_or Therapy.pdf	Form and Instruction
ds4183 - MH survey (signed).pdf DS-4183	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Survey	Mental Health Surveys	1. Questions 1 & 2.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Survey	Mental Health Surveys	2. Question 3.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Survey	Mental Health Surveys	3. Question 4 - Question about RMOP Service.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Survey	Mental Health Surveys	4. Question 5 & 6 (9 questions total) - Questions about RMOP Service - Counseling and_or Therapy.pdf	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title: Mental Health Surveys

FR Citation: 89 FR 12316

Number of Respondents: 14,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14,000	14,000
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DS-4183	ds4183 - MH survey (signed).pdf	03/12/2024

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