View Information Collection (IC)
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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Facilities Universe in 2014 and 2016
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
2014 N-MHSS (Full-Scale) Paper Questionnaire
2014 N-MHSS (Full-Scale) Paper Questionnaire
Attachment A1 - 2014 N-MHSS (Full-Scale) Paper Questionnaire.docx
Yes
Yes
Fillable Printable
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:
17,000
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 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
17,000
0
2,000
0
0
15,000
Annual IC Time Burden (Hours)
12,750
0
6,450
0
0
6,300
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
2014 N-MHSS CATI Questionnaire
Attachment A4 - 2014 N-MHSS CATI Questionnaire.docx
11/25/2013
2014 N-MHSS Web Screens for Online Questionnaire
Attachment A3 - 2014 N-MHSS Web Screens for Online Questionnaire.docx
11/25/2013
2014 N-MHSS Advance Letter
Attachment A5 - 2014 N-MHSS Advance Letter.docx
11/25/2013
2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 1
Attachment A6 - 2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 1.doc
11/25/2013
2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 2
Attachment A6 - 2014 N-MHSS Cover Letter (First Mailing) and Online Questionnaire Access Instructions_Pg 2.docx
11/25/2013
2014 N-MHSS First Thank You-Reminder Letter
Attachment A7 - 2014 N-MHSS First Thank You-Reminder Letter.docx
11/25/2013
2014 N-MHSS Second Thank You-Reminder Letter
Attachment A8 - 2014 N-MHSS Second Thank You-Reminder Letter.docx
11/25/2013
2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 1
Attachment A9 - 2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 1.docx
11/25/2013
2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 2
Attachment A9 - 2014 N-MHSS Cover Letter (Second Mailing) and Online Questionnaire Access Instructions_Pg 2.docx
11/25/2013
2014 N-MHSS Thank You Notification for Completed Surveys
Attachment A10 - 2014 N-MHSS Thank You Notification for Completed Surveys.docx
11/25/2013
2014 N-MHSS Online Information Site Materials_FAQs
Attachment A11 - 2014 N-MHSS Online Information Site Materials_FAQs.docx
11/25/2013
2014 N-MHSS Online Information Site Materials_Page 1
Attachment A11 - 2014 N-MHSS Online Information Site Materials_Page 1.docx
11/25/2013
List of Expert Panel Members_Nov 2011
Attachment A12 - List of Expert Panel Members_Nov 2011.docx
11/25/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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