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Federal forms, ICRs, and supporting documents

Information Collection

NHBS Behavioral Assessment Survey (HET)

IC 196958 under ICR 202504-0920-007 · OMB 0920-0770.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form
Form
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

NHBS Behavioral Assessment Survey (HET) 0920-25-0074
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0770 Behavioral Assessment for HET (English) Att 3d_Behavioral Assessmnet HET_Eng.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0770 Behavioral Assessment for HET (Spanish) Att 4d_Behavioral Assessment HET_Span.docx Yes Yes Fillable Fileable
Form 0920-25-0074 Behavioral_Assessment_HET_Spanish Att 4d_Behavioral_Assessment_HET_Span_clean.docx Yes Yes Fillable Fileable
Form 0920-25-0074 Behavioral_Assessment_HET_English Att 3d_Behavioral_Assessment_HET_Eng_clean.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

3,333 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,333 0 0 0 0 3,333
Annual IC Time Burden (Hours) 1,723 0 0 0 0 1,723
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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