Information Collection

Interview

IC 195358 under ICR 202509-0930-012 · OMB 0930-0110.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form In Person Intervie Interview	Form and Instruction
Form In Person Intervie In Person Interview Interview	Form and Instruction
Form Web Interview Web Interview Interview	Form and Instruction
Form In Person CAI Ques In Person CAI Questionnaire Interview	Form and Instruction
Form Web-based CAI Ques Web-based CAI Questionnaire Interview	Form and Instruction
In Person Intervie In Person Interview 2025 In-Person IVW English_11725.docx	Form and Instruction
In Person Intervie In Person Interview 2025 In-Person IVW English_112525clean.docx	Form and Instruction
Web Interview Web Interview 2025 Web IVW English_11725.docx	Form and Instruction
Web Interview Web Interview 2025 Web IVW English_11725_clean.docx	Form and Instruction
In Person CAI Ques In Person CAI Questionnaire Attachment N_In-Person CAI Questionnaire.docx	Form and Instruction
In Person CAI Ques In Person CAI Questionnaire Attachment N_In-Person CAI Questionnaire.docx	Form and Instruction
Web-based CAI Ques Web-based CAI Questionnaire Attachment WEB-4_Web-based CAI Questionnaire_6-9-25_Tracked-KPAB.docx	Form and Instruction
Web-based CAI Ques Web-based CAI Questionnaire Attachment WEB-4_Web-based CAI Questionnaire_6-9-25_Tracked-KPAB.docx	Form and Instruction

IC Title:

Interview

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	In Person Interview	Yes	Yes	Fillable Fileable
Form and Instruction	Web Interview	Yes	Yes	Fillable Fileable
Form and Instruction	In Person CAI Questionnaire	Yes	Yes	Fillable Fileable
Form and Instruction	Web-based CAI Questionnaire	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Alcohol, Drug Abuse, and Mental Health Epidemiologic Data (HHS/SAMHSA/OA)

FR Citation: 84 FR 27341

Number of Respondents: 67,507

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	67,507	67,507
Annual IC Time Burden (Hours)	68,047	68,047
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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