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Post-Training Survey
Evaluation of the Mental Health First Aid Program
OMB: 0930-0371
IC ID: 222625
OMB.report
HHS/SAMHSA
OMB 0930-0371
ICR 201607-0930-002
IC 222625
( )
Documents and Forms
Document Name
Document Type
Form Post-Training Surv
Post-Training Survey
Form and Instruction
Post-Training Surv Post-Training Survey
2__Attachment 2 - MHFA post training survey 052616.pdf
Form and Instruction
6__Attachment 6 - MHFA Evaluation consent form for post-training survey 02 24 16.pdf
Post-Training Consent FormSurvey
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Post-Training Survey
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
Post-Training Survey
Post-Training Survey
2__Attachment 2 - MHFA post training survey 052616.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
22,800
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
22,800
0
22,800
0
0
0
Annual IC Time Burden (Hours)
5,700
0
5,700
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Post-Training Consent FormSurvey
6__Attachment 6 - MHFA Evaluation consent form for post-training survey 02 24 16.pdf
07/26/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.