Information Collection

[NCIPC] Mental Health Data Channel (MHDC) Feedback Survey

IC 279323 under ICR 202506-0920-002 · OMB 0920-1050.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-26-0128 Baseline Questionnaire [NCIPC] Mental Health Data Channel (MHDC) Feedback Survey	Form and Instruction
0920-26-0128 Baseline Questionnaire REDCap_MHDCBaselineSurvey_Att 1.pdf	Form and Instruction
Customer Service GenIC Clearance_final_MHDC.docx GenIC Request	IC Document

IC Title:

Agency IC Tracking Number:

0920-26-0128

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-26-0128				Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	9	9
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request		03/05/2026

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

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