Information Collection

Voluntary Customer Satisfaction Surveys to Implement Executive order 12862 in the Substance Abuse and Mental Health Services Administration

IC 179640 under ICR 200704-0930-005 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OAS #1 Voluntary Customer Satisfaction Surveys to Implement Executive order 12862 in the Substance Abuse and Mental Health Services Administration	Form
OAS #1 OAS Survey 0930-0197 OAS-Survey.doc	Form

IC Title:

Voluntary Customer Satisfaction Surveys to Implement Executive order 12862 in the Substance Abuse and Mental Health Services Administration

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	OAS #1	OAS Survey	0930-0197 OAS-Survey.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

table that charts list of burden
	Requested	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	30,150	0	0	0	0	0
Annual IC Time Burden (Hours)	15,075	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
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.