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Qualitative Interviews
Evaluation of the Mental Health First Aid Program
OMB: 0930-0371
IC ID: 222627
OMB.report
HHS/SAMHSA
OMB 0930-0371
ICR 201607-0930-002
IC 222627
( )
Documents and Forms
Document Name
Document Type
Form Qualitative Interv
Qualitative Interviews
Form and Instruction
Qualitative Interv Qualitative Interview Protocol
4__Attachment 4 - MHFA evaluation - Qualitative Interview Protocol.pdf
Form and Instruction
8__Attachment 8 - MHFA Evaluation consent form for interviews 2 24 16.pdf
Qualitative Interview Consent Form
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Qualitative Interviews
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
Qualitative Interview Protocol
Qualitative Interview Protocol
4__Attachment 4 - MHFA evaluation - Qualitative Interview Protocol.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:
23
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
23
0
23
0
0
0
Annual IC Time Burden (Hours)
17
0
17
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Qualitative Interview Consent Form
8__Attachment 8 - MHFA Evaluation consent form for interviews 2 24 16.pdf
07/26/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.