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Retention of Behavior Health Providers Survey
Retention of Behavior Health Providers Survey
OMB: 0720-0043
IC ID: 192473
OMB.report
DOD/DODOASHA
OMB 0720-0043
ICR 201004-0720-001
IC 192473
( )
Documents and Forms
Document Name
Document Type
Letters-Reminders-Phone Script.pdf.pdf
Other-Supplemental Information
Survey Former Providers.docx
Other-Survey
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Retention of Behavior Health Providers 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
Other-Supplemental Information
Letters-Reminders-Phone Script.pdf.pdf
No
Paper Only
Other-Survey
Survey Former Providers.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Defense and National Security
Subfunction:
Operational Defense
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
164
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
50 %
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
164
0
164
0
0
0
Annual IC Time Burden (Hours)
41
0
41
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.