Mental Health Surveys

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Documents and Forms

Document Name Document Type
Form Survey Mental Health Surveys Form and Instruction
Survey Mental Health Surveys 1. Questions 1 & 2.pdf Form and Instruction
Survey Mental Health Surveys 2. Question 3.pdf Form and Instruction
Survey Mental Health Surveys 3. Question 4 - Question about RMOP Service.pdf Form and Instruction
Survey Mental Health Surveys 4. Question 5 & 6 (9 questions total) - Questions about RMOP Service - Counseling and_or Therapy.pdf Form and Instruction
ds4183 - MH survey (signed).pdf DS-4183 IC Document

Information Collection (IC) Details

IC Title:	Mental Health Surveys	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Survey	Mental Health Surveys	1. Questions 1 & 2.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Survey	Mental Health Surveys	2. Question 3.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Survey	Mental Health Surveys	3. Question 4 - Question about RMOP Service.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Survey	Mental Health Surveys	4. Question 5 & 6 (9 questions total) - Questions about RMOP Service - Counseling and_or Therapy.pdf	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: Mental Health Surveys	FR Citation: 89 FR 12316

Number of Respondents: 14,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14,000	14,000
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
DS-4183	ds4183 - MH survey (signed).pdf	03/12/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.