Web Site Registration

Registration for Behavioral Health Web Site and Resources

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0313 can be found here:

Documents and Forms

Document Name Document Type
Form Attachment 2 - Scr Web Site Registration Form and Instruction
Attachment 1 - Scr Attachment 1 - Screen Shot Web Registration Form Attachment 1 - Screen shot of first Web registration form - Create Login.JPG Form and Instruction
Attachment 2 - Scr Attachment 2 - Screen Shot Web Registration Form Attachment 2 - Screen shot of second Web registration form - Account Information.JPG Form and Instruction
Attachment 4 - SAMHSA Data collection questions and Values_3_29_10.doc Attachment 4 - Questions and Values IC Document

Information Collection (IC) Details

IC Title:	Web Site Registration	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
Form and Instruction	Attachment 2 - Screen Shot Web Registration Form	Attachment 2 - Screen Shot Web Registration Form	Attachment 2 - Screen shot of second Web registration form - Account Information.JPG		Yes	Yes	Paper Only
Form and Instruction	Attachment 1 - Screen Shot Web Registration Form	Attachment 1 - Screen Shot Web Registration Form	Attachment 1 - Screen shot of first Web registration form - Create Login.JPG		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 41,200	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	41,200	41,200
Annual IC Time Burden (Hours)	1,360	1,360
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 4 - Questions and Values	Attachment 4 - SAMHSA Data collection questions and Values_3_29_10.doc	08/05/2010

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