Information Collection Request
National Household Survey on Behavioral Health (NHSBH)
ICR 202408-0930-003 · OMB 0930-0110 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0930-0110 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form In-Person Screenin Household Screening |
Form and Instruction | Modified | Repair queued |
| Form 2025 CATI Verifica Interview Verification |
Form and Instruction | Modified | Missing upstream |
| Form 2025 CATI Verifica Screening Verification |
Form and Instruction | Modified | Repair queued |
| Form In-Person CAI Ques Interview |
Form and Instruction | Modified | Repair queued |
 Attachment WEB-7_Web Incentive Thank You Letters_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment WEB-5_Web Parental Permission Script_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment WEB-3_Web Follow-up Letters_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment WEB-2_Web Study Description_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment WEB-1_Web Q&A Brochure_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
 Lead Letter Focus Group Addendum.docx |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment X_NonresponseAmongSampleMembers50andOlder.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment W_Doorperson Card_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Missing upstream |
 Attachment U_Certificate of Participation_2025.pptx |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment S_State Highlight.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment R_Data Security Handout_2025_Clean.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment Q_Engaging Respondents Handout_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment P_Participant Code Card_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment O_NHSBH Highlights.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-17_CATI-CMS Phone Prompting Scripts.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-16_Follow-up Interview Sched Letter Template_Final.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-15_Follow-up Interview UTC Letter Template_Final.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-14_Follow-up Interview Refusal Letter Template.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-13_Follow-up Int Confirmation Scripts.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-12_Email Voicemail Contacting Scripts.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-11_Follow-up Int Text System Messages.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-10_Scheduler Automated Emails.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-9_Distressed Respondent Protocol_Final.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-8_Follow-up Interview Incentive Receipt 2024_final.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-7_Follow-up Study Description.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-6_Follow-up Interview Ext Informed Consent.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-5_Follow-up Interview Informed Consent.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-4_Blaise Instrument Specs.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-3_Follow-up Interview Scheduler Card.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-2_Follow-up Int Recruitment Script.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment MICS-1_NetSCID Instrument Specs_Final.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment M_ConfAgree_DCA_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment L_Parental Intro Scripts_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment K_Showcard Booklet_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment J_Introduction and Informed Consent 2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment B_In Person Q&A Brochure_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment I_Federalwide Assurance_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment H_Interview Incentive Receipt 2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment G_Refusal Letters_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment F_UTC and CA Letters_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment E_Study Description_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment D_Contact Cards.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment C_Tablet Video Scripts_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| Attachment A_Lead Letter_2025.pdf |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
 Attachment Y_Public Comments Response Matrix.xlsx |
Supplementary Document | Uploaded 2024-08-07 | Repair queued |
| NHSBH-SSB _Final.docx |
Supporting Statement B | Uploaded 2024-08-07 | Repair queued |
| NHSBH-SSA _Final.docx |
Supporting Statement A | Uploaded 2024-08-07 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 43643 |  Household Screening |
Form and Instruction | Modified | |
| 195362 | Interview Verification |
Form and Instruction | Modified | |
| 195361 | Screening Verification |
Form and Instruction | Modified | |
| 195358 | Interview |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/SAMHSA |
| OMB Control No | 0930-0110 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202404-0930-002 |
| Agency Tracking No | 19864 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |