Information Collection Request

Mental Health Assessment Form, Public Health Investigation Form: Active TB, and Public Health Investigation Form: Non-TB Illness

ICR 202410-0970-005 · OMB 0970-0509 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Public Health Investigation Form: Non-TB Illness - Recordkeeping Time Form Unchanged Repair queued
Form 1 Public Health Investigation Form: Active TB - Recordkeeping Time Form Unchanged Repair queued
Form 1 Mental Health Assessment Form - Recordkeeping Time Form Unchanged Repair queued
Form 1 Public Health Investigation Form: Non-TB Illness - Reporting Time Form Unchanged Repair queued
Form 1 Public Health Investigation Form: Active TB - Reporting Time Form Unchanged Repair queued
Form 1 Mental Health Assessment Form - Reporting Time Form Unchanged Repair queued
NonSub Change Request_0466 and 0509_FINAL_10.4.24 (002).docx Justification for No Material/Nonsubstantive Change Uploaded 2024-10-04 Available
30 Day FRN_Data Sharing Updates _0970-0466 and 0970-0509_7.2.24.pdf Supplementary Document Uploaded 2024-10-04 Repair queued
NonSub Change Request - MH Assessment Form and PH Ivest Forms -ROCIS title.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-09-18 Repair queued
Supporting Statement A_Mental Health Assessment and Public Health Investigation Forms_v2.docx Supporting Statement A Uploaded 2024-10-04 Repair queued
Attachment B_Mental Health Assessment Form Instructional Letter for Mental Health Providers.docx Supplementary Document Uploaded 2023-08-03 Available
Attachment A_Flores Agreement.docx Supplementary Document Uploaded 2023-08-03 Missing upstream

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
09/30/2026 09/30/2026
207,800 207,800
17,406 17,406
0 0





table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 207,800 207,800 0 0 0 0
Annual Time Burden (Hours) 17,406 17,406 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No