Primary Data Collection

2012 National Mental Health Services Survey (N-MHSS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0119 can be found here:

Documents and Forms

Document Name Document Type
Form Locator Questionna Primary Data Collection Form and Instruction
Locator Questionna Locator Questionnaire Attachment A1 - Questionnaire.docx Form and Instruction
Attachment A3 - CATI Questionnaire.docx CATI Questionnaire IC Document
Attachment A2 - Web Screens-Questionnaire.docx Web Screens IC Document
Attachment A4 - Advance Letter.docx Advance Letter IC Document
Attachment A5 - Cover Letter.docx Advance Letter IC Document
Attachment A6 - Thank You-Reminder Letter.docx Thank You-Reminder Letter IC Document
Attachment A7 - Information Site Materials.docx Information Site Materials IC Document
Attachment A8 - Expert Panel.docx Expert Panel IC Document

Information Collection (IC) Details

IC Title:	Primary Data Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Locator Questionnaire	Locator Questionnaire	Attachment A1 - Questionnaire.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	15,000	2,000	0	13,000
Annual IC Time Burden (Hours)	6,300	0	-6,700	13,000
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
CATI Questionnaire	Attachment A3 - CATI Questionnaire.docx	05/04/2012
Web Screens	Attachment A2 - Web Screens-Questionnaire.docx	05/04/2012
Advance Letter	Attachment A4 - Advance Letter.docx	05/04/2012
Advance Letter	Attachment A5 - Cover Letter.docx	05/04/2012
Thank You-Reminder Letter	Attachment A6 - Thank You-Reminder Letter.docx	05/04/2012
Information Site Materials	Attachment A7 - Information Site Materials.docx	05/04/2012
Expert Panel	Attachment A8 - Expert Panel.docx	05/04/2012

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