Information Collection

National Cross-Site Assessment of Addiction Technology Transfer Centers (ATTC) Network

IC 7618 under ICR 200701-0930-003 · OMB 0930-0216.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0216 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1.1 ATTC Event Des National Cross-Site Assessment of Addiction Technology Transfer Centers (ATTC) Network	Form and Instruction
1.1 ATTC Event Des ATTC Event Description Form Attachment 1-1 ATTC Event Description Form.doc	Form and Instruction
1.2 ATTC Pre-Event ATTC Pre-Event Form Meetings & TA Attachment 1-2 ATTC PreEvent Form Meetings & TA.doc	Form and Instruction
1.3 ATTC Pre-Event ATTC Pre-Event Form Training Attachment 1-3 ATTC PreEvent Form Training.doc	Form and Instruction
1.4 ATTC Post Even ATTC Post Event Cust Sat Survey Training Attachment 1-4 ATTC PostEvent Customer Satis Survey Training.doc	Form and Instruction
2.4 CSAT Customer CSAT Customer Sat Survey TA Follow-up Attachment 2-4 CSAT Cust Satis Survey TA Followup.doc	Form and Instruction
1.5 ATTC Follow-up ATTC Follow-up Event Cust Sat Survey Training Attachment 1-5 ATTC FollowUp Customer Satis Survey Training.doc	Form and Instruction
2.1 CSAT Customer CSAT Customer Sat Survey Meeting Attachment 2-1 CSAT Cust Satis Survey Meeting.doc	Form and Instruction
2.2 CSAT Customer CSAT Customer Sat Survey Meeting Follow-up Attachment 2-2 CSAT Cust Satis Survey Meeting Followup.doc	Form and Instruction
2.3 CSAT Customer CSAT Customer Sat Survey TA Attachment 2-3 CSAT Cust Satis Survey TA.doc	Form and Instruction
2.5 CSAT Customer CSAT Customer Sat Survey Training Attachment 2-5 CSAT Cust Satis Survey Training.doc	Form and Instruction
2.6 CSAT Customer CSAT Customer Sat Survey Training Follow-up Attachment 2-6 CSAT Cust Satis Survey Training Followup.doc	Form and Instruction
Attachment 3 ATTC Network Regional Centers.doc Attachment 3 ATTC Net Reg Centers	IC Document
Attachment 4 Sample Cover Letters.doc Attachment 4 Sample Cover Letters	IC Document
Attachment 5 Cover page for instruments.doc Attachment 5 Cover Page Instructions	IC Document
Attachment 6 Model Statement.doc Attachment 6 Model Statement	IC Document
Attachment 7 Contact Information Form.doc Attachment 7 Contact Information Form	IC Document
Attachment 8 Statement of Informed Consent for Followup.doc Attachment 8 Statement of Informed Consent	IC Document
Terms-06-Memo.doc Terms Memo	IC Document
Terms-06-Report.doc Terms Report	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

National Cross-Site Assessment of Addiction Technology Transfer Centers (ATTC) Network

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1.1 ATTC Event Description Form	ATTC Event Description Form	Attachment 1-1 ATTC Event Description Form.doc	No	No	Paper Only
Form and Instruction	1.2 ATTC Pre-Event Form Meetings & TA	ATTC Pre-Event Form Meetings & TA	Attachment 1-2 ATTC PreEvent Form Meetings & TA.doc	No	No	Paper Only
Form and Instruction	1.3 ATTC Pre-Event Form Training	ATTC Pre-Event Form Training	Attachment 1-3 ATTC PreEvent Form Training.doc	No	No	Paper Only
Form and Instruction	2.4 CSAT Customer Sat Survey TA Follow-up	CSAT Customer Sat Survey TA Follow-up	Attachment 2-4 CSAT Cust Satis Survey TA Followup.doc	No	No	Paper Only
Form and Instruction	1.5 ATTC Follow-up Event Cust Sat Survey Training	ATTC Follow-up Event Cust Sat Survey Training	Attachment 1-5 ATTC FollowUp Customer Satis Survey Training.doc	No	No	Paper Only
Form and Instruction	2.1 CSAT Customer Sat Survey Meeting	CSAT Customer Sat Survey Meeting	Attachment 2-1 CSAT Cust Satis Survey Meeting.doc	No	No	Paper Only
Form and Instruction	2.2 CSAT Customer Sat Survey Meeting Follow-up	CSAT Customer Sat Survey Meeting Follow-up	Attachment 2-2 CSAT Cust Satis Survey Meeting Followup.doc	No	No	Paper Only
Form and Instruction	2.3 CSAT Customer Sat Survey TA	CSAT Customer Sat Survey TA	Attachment 2-3 CSAT Cust Satis Survey TA.doc	No	No	Paper Only
Form and Instruction	2.5 CSAT Customer Sat Survey Training	CSAT Customer Sat Survey Training	Attachment 2-5 CSAT Cust Satis Survey Training.doc	No	No	Paper Only
Form and Instruction	2.6 CSAT Customer Sat Survey Training Follow-up	CSAT Customer Sat Survey Training Follow-up	Attachment 2-6 CSAT Cust Satis Survey Training Followup.doc	No	No	Paper Only
Form and Instruction	1.4 ATTC Post Event Cust Sat Survey Training	ATTC Post Event Cust Sat Survey Training	Attachment 1-4 ATTC PostEvent Customer Satis Survey Training.doc	No	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 10 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	200	2,190	-27,440	2,190	23,260
Annual IC Time Burden (Hours)	50	0	-6,960	0	7,010
Annual IC Cost Burden (Dollars)	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 3 ATTC Net Reg Centers	Attachment 3 ATTC Network Regional Centers.doc	12/28/2006
Attachment 4 Sample Cover Letters	Attachment 4 Sample Cover Letters.doc	12/28/2006
Attachment 5 Cover Page Instructions	Attachment 5 Cover page for instruments.doc	12/28/2006
Attachment 6 Model Statement	Attachment 6 Model Statement.doc	12/28/2006
Attachment 7 Contact Information Form	Attachment 7 Contact Information Form.doc	12/28/2006
Attachment 8 Statement of Informed Consent	Attachment 8 Statement of Informed Consent for Followup.doc	12/28/2006
Terms Memo	Terms-06-Memo.doc	12/28/2006
Terms Report	Terms-06-Report.doc	12/28/2006

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