HP Survey 2021

Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access Program and the Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0074 can be found here:

Documents and Forms

Document Name Document Type
Form 1 HP Survey 2021 Form and Instruction
1 HP Survey Attachment B1 - HP Survey1 - Copy.docx Form and Instruction
1 HP Survey Attachment B1 - HP Survey1 - Copy.docx Form and Instruction

Information Collection (IC) Details

IC Title:	HP Survey 2021	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	1	HP Survey	Attachment B1 - HP Survey1 - Copy.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,031	Number of Respondents for Small Entity: 8,029

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,031	8,031
Annual IC Time Burden (Hours)	6,023	6,023
Annual IC Cost Burden (Dollars)	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.