Baseline Survey -- Treatment Group

Mental Health Treatment Study (MHTS)

Documents and Forms

Document Name Document Type
Baseline Questionnaire.doc Other-Survey
MHTS Consent (incl FAQs).doc Other-Consent Letter

Information Collection (IC) Details

IC Title:	Baseline Survey -- Treatment Group	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
Other-Consent Letter			MHTS Consent (incl FAQs).doc		No		Paper Only
Other-Survey			Baseline Questionnaire.doc		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,121	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,121	1,121
Annual IC Time Burden (Hours)	878	878
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.