Information Collection

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

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	[NCIPC] Mental Health Data Channel (MHDC) Feedback Survey	Agency IC Tracking Number:	0920-26-0128

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	0920-26-0128	Baseline Questionnaire	REDCap_MHDCBaselineSurvey_Att 1.pdf		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 %

	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

Title	Document	Date Uploaded
GenIC Request	Customer Service GenIC Clearance_final_MHDC.docx	03/05/2026

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].