Survey Instrument

OMB No. 0930-0197 Expiration Date: 12/31/2007

SAMHSA.gov

The Substance Abuse & Mental Health Services Administration

Public Burden Statement: 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 0930-0197.  Public reporting burden for this collection of information is estimated to average 4 minutes per client per year, 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, 1 Choke Cherry Road, Room 7-1044, Rockville, Maryland, 20857.

Office of Applied Studies (OAS)

Your Opinion is Important To Us!

Help Improve Our Service To You By Providing Valuable Feedback!

The Office of Applied Studies (OAS) provides a variety of services, such as publications, presentations, web reports, public use files, and responses to data requests. OAS is committed to providing high quality services, gaining insight regarding customer satisfaction, and targeting areas in need of improvement. We take pride in our work and value your feedback to ensure we maintain an excellent level of performance. Please take a few moments to complete this survey so we can continue to serve you better. We welcome your comments.

Sincerely yours,

Anna Marsh, Ph.D.

Acting Director, Office of Applied Studies

Substance Abuse and Mental Health Services Administration

Federal Employees - Click here to start •. All Others - Click here to start •.

SAMHSA.gov

The Substance Abuse & Mental Health Services Administration

Office of Applied Studies (OAS)

Customer Satisfaction Survey

Which OAS service did you receive? (check all that apply)

Report___ Data____ Web Link or Web Info____ Public Use File____ Presentation____ Other_____

Who provided you with this service? ____________________________

What was the date(s) of this service? ___________________________

Responsiveness (How well was your request filled?): Excellent____, Good_____, Fair____, Poor____, N/A__

Timeliness of service: Excellent_____, Good_____, Fair_____, Poor_____, N/A_____

Courtesy of OAS employee(s) providing the service: Excellent___, Good___, Fair___, Poor_____, N/A___

Overall satisfaction: Very Satisfied_____, Satisfied_____, Unsatisfied_____, Very Unsatisfied_____

Please provide any suggestions on further improving our service? Comment box

Additional comments: Comment box

May we contact you regarding your experience with this service? Yes, no

Name: (optional) ______________________________

Phone Number: (optional) _______________________

Email: (optional) ______________________________

Agency/organization: (optional) __________________