National Household Survey on Behavioral Health (NHSBH)

ICR 202408-0930-003

OMB: 0930-0110

Federal Form Document

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0930-0110 can be found here:

2025-09-30 - No material or nonsubstantive change to a currently approved collection
2025-04-27 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Document Name	Status
Form In-Person Screenin Household Screening Form and Instruction	Modified
Form 2025 CATI Verifica Interview Verification Form and Instruction	Modified
Form 2025 CATI Verifica Screening Verification Form and Instruction	Modified
Form In-Person CAI Ques Interview Form and Instruction	Modified
Attachment WEB-7_Web Incentive Thank You Letters_2025.pdf Supplementary Document	2024-08-07
Attachment WEB-5_Web Parental Permission Script_2025.pdf Supplementary Document	2024-08-07
Attachment WEB-3_Web Follow-up Letters_2025.pdf Supplementary Document	2024-08-07
Attachment WEB-2_Web Study Description_2025.pdf Supplementary Document	2024-08-07
Attachment WEB-1_Web Q&A Brochure_2025.pdf Supplementary Document	2024-08-07
Lead Letter Focus Group Addendum.docx Supplementary Document	2024-08-07
Attachment X_NonresponseAmongSampleMembers50andOlder.pdf Supplementary Document	2024-08-07
Attachment W_Doorperson Card_2025.pdf Supplementary Document	2024-08-07
Attachment U_Certificate of Participation_2025.pptx Supplementary Document	2024-08-07
Attachment S_State Highlight.pdf Supplementary Document	2024-08-07
Attachment R_Data Security Handout_2025_Clean.pdf Supplementary Document	2024-08-07
Attachment Q_Engaging Respondents Handout_2025.pdf Supplementary Document	2024-08-07
Attachment P_Participant Code Card_2025.pdf Supplementary Document	2024-08-07
Attachment O_NHSBH Highlights.pdf Supplementary Document	2024-08-07
Attachment MICS-17_CATI-CMS Phone Prompting Scripts.pdf Supplementary Document	2024-08-07
Attachment MICS-16_Follow-up Interview Sched Letter Template_Final.pdf Supplementary Document	2024-08-07
Attachment MICS-15_Follow-up Interview UTC Letter Template_Final.pdf Supplementary Document	2024-08-07
Attachment MICS-14_Follow-up Interview Refusal Letter Template.pdf Supplementary Document	2024-08-07
Attachment MICS-13_Follow-up Int Confirmation Scripts.pdf Supplementary Document	2024-08-07
Attachment MICS-12_Email Voicemail Contacting Scripts.pdf Supplementary Document	2024-08-07
Attachment MICS-11_Follow-up Int Text System Messages.pdf Supplementary Document	2024-08-07
Attachment MICS-10_Scheduler Automated Emails.pdf Supplementary Document	2024-08-07
Attachment MICS-9_Distressed Respondent Protocol_Final.pdf Supplementary Document	2024-08-07
Attachment MICS-8_Follow-up Interview Incentive Receipt 2024_final.pdf Supplementary Document	2024-08-07
Attachment MICS-7_Follow-up Study Description.pdf Supplementary Document	2024-08-07
Attachment MICS-6_Follow-up Interview Ext Informed Consent.pdf Supplementary Document	2024-08-07
Attachment MICS-5_Follow-up Interview Informed Consent.pdf Supplementary Document	2024-08-07
Attachment MICS-4_Blaise Instrument Specs.pdf Supplementary Document	2024-08-07
Attachment MICS-3_Follow-up Interview Scheduler Card.pdf Supplementary Document	2024-08-07
Attachment MICS-2_Follow-up Int Recruitment Script.pdf Supplementary Document	2024-08-07
Attachment MICS-1_NetSCID Instrument Specs_Final.pdf Supplementary Document	2024-08-07
Attachment M_ConfAgree_DCA_2025.pdf Supplementary Document	2024-08-07
Attachment L_Parental Intro Scripts_2025.pdf Supplementary Document	2024-08-07
Attachment K_Showcard Booklet_2025.pdf Supplementary Document	2024-08-07
Attachment J_Introduction and Informed Consent 2025.pdf Supplementary Document	2024-08-07
Attachment B_In Person Q&A Brochure_2025.pdf Supplementary Document	2024-08-07
Attachment I_Federalwide Assurance_2025.pdf Supplementary Document	2024-08-07
Attachment H_Interview Incentive Receipt 2025.pdf Supplementary Document	2024-08-07
Attachment G_Refusal Letters_2025.pdf Supplementary Document	2024-08-07
Attachment F_UTC and CA Letters_2025.pdf Supplementary Document	2024-08-07
Attachment E_Study Description_2025.pdf Supplementary Document	2024-08-07
Attachment D_Contact Cards.pdf Supplementary Document	2024-08-07
Attachment C_Tablet Video Scripts_2025.pdf Supplementary Document	2024-08-07
Attachment A_Lead Letter_2025.pdf Supplementary Document	2024-08-07
Attachment Y_Public Comments Response Matrix.xlsx Supplementary Document	2024-08-07
NHSBH-SSB _Final.docx Supporting Statement B	2024-08-07
NHSBH-SSA _Final.docx Supporting Statement A	2024-08-07

IC Document Collections

IC ID	Document Title	Status
43643	Household Screening Form and Instruction	Modified
195362	Interview Verification Form and Instruction	Modified
195361	Screening Verification Form and Instruction	Modified
195358	Interview Form and Instruction	Modified

ICR Details