MICS-Follow-up Study Description

Attachment MICS-7_Follow-up Study Description.pdf

National Household Survey on Behavioral Health (NHSBH)

MICS-Follow-up Study Description

OMB: 0930-0110

Document [pdf]
Download: pdf | pdf
Follow-up Study
Description
You have been selected for a follow-up study to the National Survey on Drug Use
and Health. This study, sponsored by the U.S. Department of Health and Human
Services, will ask questions about mental health and consists of one interview.
If you decide to participate in the follow-up interview, your first name, telephone
number, and email address will be collected so we can contact you about your
interview. To schedule an interview appointment, you can either select a date
and time through the study’s online scheduling system or when speaking to the
interviewer who contacts you.
The interview should take about 60 minutes to complete. Your participation is
voluntary, you can refuse to answer any questions you do not want to answer,
and you can stop the interview at any time. The interview will be conducted
using Zoom. You can be in your home, office, or another private location when
you complete the interview. You will be asked for permission to record the
interview to ensure the interviewer administered the interview properly. You can
still be interviewed even if you do not allow the interview to be recorded. Your
interview recording may be used for quality or training purposes. If you agree
to complete the interview, you will receive $30.
Federal law requires us to keep all of your answers private and confidential. Any
data you provide will only be accessed by authorized personnel for statistical
purposes according to the Confidential Information Protection and Statistical
Efficiency Act of 2002. The only exceptions to this promise of confidentiality are if
you tell the interviewer that you intend to seriously harm yourself or someone
else, or if a child has been or will be seriously harmed. In this situation, the
interviewer may need to notify a mental health professional or other authorities.
If you have questions about the study, call the Project Representative at 1-800848-4079. If you have questions about your rights as a study participant, call
RTI International’s Office of Research Protection at 1-866-214-2043 (a toll-free
number).
Thank you for your cooperation and time.
Your confidentiality is protected by the Confidential Information Protection and Statistical Efficiency
Act of 2002 (CIPSEA, PL 107-347). Any project staff or authorized data user who violates CIPSEA
may be subject to a jail term of up to 5 years, a fine of up to $250,000, or both.
NOTICE: Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to
SAMHSA Reports Clearance Officer, Paperwork Reduction Project (0930-0110), Center for Behavioral Health Statistics and Quality; Room 15E57B;
5600 Fishers Lane, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0110, expiration date 10/31/24.


File Typeapplication/pdf
File TitleMicrosoft Word - Attachment MICS-7_Follow-up Study Description_2024
Authorcjewett
File Modified2023-11-15
File Created2023-11-15

© 2024 OMB.report | Privacy Policy