Interview

National Household Survey on Behavioral Health (NHSBH)

Documents and Forms

Document Name Document Type
Form In-Person CAI Ques Interview Form and Instruction
In-Person CAI Ques In-Person CAI Questionnaire Attachment N_In-Person CAI Questionnaire_v2.pdf Form and Instruction
In-Person CAI Ques In-Person CAI Questionnaire Attachment N_In-Person CAI Questionnaire_Final 9-30-24.pdf Form and Instruction
Web-based CAI Ques Web-based CAI Questionnaire Attachment WEB-4_Web-based CAI Questionnaire.pdf Form and Instruction
Web-based CAI Ques Web-based CAI Questionnaire Attachment WEB-4_Web-based CAI Questionnaire_Final 9-30-24.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	In-Person CAI Questionnaire	In-Person CAI Questionnaire	Attachment N_In-Person CAI Questionnaire_Final 9-30-24.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	Web-based CAI Questionnaire	Web-based CAI Questionnaire	Attachment WEB-4_Web-based CAI Questionnaire_Final 9-30-24.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Alcohol, Drug Abuse, and Mental Health Epidemiologic Data (HHS/SAMHSA/OA)	FR Citation: 84 FR 27341

Number of Respondents: 67,507	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	Previously Approved
Annual Number of Responses for this IC	67,507	0	67,507
Annual IC Time Burden (Hours)	68,047	540	67,507
Annual IC Cost Burden (Dollars)	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.