Health Professional Survey

Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access and Screening and Treatment for Maternal Mental Health and Substance Use Disorders Programs Project

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0105 can be found here:

Documents and Forms

Document Name Document Type
Form B1 Health Professional Survey Form and Instruction
B1 Attachment B1 - Health Professional Survey PMHCA Attachment B1 - Health Professional Survey V3 2021-2023 PMHCA_NON-APPROVED_Clean_9-16-24.docx Form and Instruction
B1 Attachment B1 - Health Professional Survey PMHCA Attachment B1 - Health Professional Survey V3 2021-2023 PMHCA_NON-APPROVED_Clean_9-16-24.docx Form and Instruction
B9 Attachment B9 - Health Professional Survey MMHSUD Attachment B9 - Health Professional Survey V2 2023 MMHSUD_NON-APPROVED_Clean_9-16-24.docx Form and Instruction
B9 Attachment B9 - Health Professional Survey MMHSUD Attachment B9 - Health Professional Survey V2 2023 MMHSUD_NON-APPROVED_Clean_9-16-24.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Health Professional Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	B1	Attachment B1 - Health Professional Survey PMHCA	Attachment B1 - Health Professional Survey V3 2021-2023 PMHCA_NON-APPROVED_Clean_9-16-24.docx		Yes	Yes	Fillable Fileable
Form and Instruction	B9	Attachment B9 - Health Professional Survey MMHSUD	Attachment B9 - Health Professional Survey V2 2023 MMHSUD_NON-APPROVED_Clean_9-16-24.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 23,256	Number of Respondents for Small Entity: 23,256

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	23,256	23,256
Annual IC Time Burden (Hours)	7,674	7,674
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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