Voluntary Customer Satisfaction Surveys to Implement Executive Order 12862 in the Substance Abuse and Mental Health Services Administration (SAMHSA)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Formative Survey Formative Survey	Form and Instruction	New	Available
Form Satisfaction Surve Satisfaction Survey	Form and Instruction	New	Available
Form LC Survey LC Survey	Form and Instruction	New	Available
Form Impact Survey Impact Survey	Form and Instruction	New	Available
Form Satisfaction Surve Satisfaction Survey	Form and Instruction	New	Available
Form Formative Survey Formative Survey	Form and Instruction	New	Available
Form End-of Email Surve End-of Email Survey	Form	New	Available
Form Survey and Letters Survey and Letters	Form	New	Available
Form Survey #4 Provider Survey #4 Provider View of Decision Aid	Form and Instruction	New	Available
Form Survey #3 Consumer Survey #3 Consumer View of Decision Aid	Form and Instruction	New	Available
Form Survey #2 Provider Survey #2 Provider View of Workbook	Form and Instruction	New	Available
Form Survey #1 Consumer Survey #1 Consumer View of Workbook	Form and Instruction	New	Available
Form Webinar Evaluation Webinar Evaluation Form	Form and Instruction	New	Available
Form TA Evaluation Form TA Evaluation Form	Form and Instruction	New	Available
Form Modular Survey - O Modular Survey - OTP Questions	Form and Instruction	New	Available
Form User Feedback Form User Feedback Form	Form and Instruction	New	Available
Form Attachment A - Onl Attachment A - Online User's Survey	Form and Instruction	New	Available
Form Screen Shots Screen Shots	Form and Instruction	New	Available
Form Grant Reviewer Sur Grant Reviewer Survey	Form and Instruction	New	Available
Form Grant Applicant Su Grant Applicant Survey	Form and Instruction	New	Available
Form Modular Survey Modular Survey	Form and Instruction	New	Available
Form Forms Attachments A-J	Form and Instruction	New	Available
Form CMHS-Survey CMHS-Survey	Form and Instruction	New	Repair queued
Form Short Report Satis Short Report Satisfaction Survey	Form and Instruction	New	Available
Form Survey Survey	Form and Instruction	New	Available
Form Survey Survey	Form and Instruction	New	Available
0197-07-SS.doc	Supporting Statement B	Uploaded 2007-10-15	Available
0197-07-SS.doc	Supporting Statement A	Uploaded 2007-10-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
194863	Co-Occurring Disorders Integration and Innovation (CODI)	Form and Instruction	New	Formative Survey
194863	Co-Occurring Disorders Integration and Innovation (CODI)	Form and Instruction	New	Satisfaction Survey
194863	Co-Occurring Disorders Integration and Innovation (CODI)	Form and Instruction	New	LC Survey
194863	Co-Occurring Disorders Integration and Innovation (CODI)	Form and Instruction	New	Impact Survey
194863	Co-Occurring Disorders Integration and Innovation (CODI)	Form and Instruction	New	Satisfaction Survey
194863	Co-Occurring Disorders Integration and Innovation (CODI)	Form and Instruction	New	Formative Survey
194709	End-of Email Survey	Form	New	End-of Email Survey
194458	Child, Adolescent and Family Branch New Community Technical Assistance Visit Survey	Form	New	Survey and Letters
192574	Shared Decision-Making in Mental Health Decision Support Tools	Form and Instruction	New	Survey #4 Provider View of Decision Aid
192574	Shared Decision-Making in Mental Health Decision Support Tools	Form and Instruction	New	Survey #3 Consumer View of Decision Aid
192574	Shared Decision-Making in Mental Health Decision Support Tools	Form and Instruction	New	Survey #2 Provider View of Workbook
192574	Shared Decision-Making in Mental Health Decision Support Tools	Form and Instruction	New	Survey #1 Consumer View of Workbook
192282	Recovery to Pratice Resource Center TA and Webinar Evaluation Form	Form and Instruction	New	Webinar Evaluation Form
192282	Recovery to Pratice Resource Center TA and Webinar Evaluation Form	Form and Instruction	New	TA Evaluation Form
191756	Pilot Testing in Opioid Treatment Programs (OTPs) of Modular Survey with OTP-Speicfic Questions	Form and Instruction	New	Modular Survey - OTP Questions
190681	Suicide Prevention Assessment and Resource Kits (SPARK)	Form and Instruction	New	User Feedback Form
190367	CMHS-GPRA Satisfaction of Technical Assistance Survey	Form and Instruction	New	Attachment A - Online User's Survey
190367	CMHS-GPRA Satisfaction of Technical Assistance Survey	Form and Instruction	New	Screen Shots
190172	The Grant Applicant and the The Grant Reviewer Surveys	Form and Instruction	New	Grant Reviewer Survey
190172	The Grant Applicant and the The Grant Reviewer Surveys	Form and Instruction	New	Grant Applicant Survey
189574	The Modular Survey on Consumer Perceptions of Care - CSAT	Form and Instruction	New	Modular Survey
188132	Fetal Alcohol Spectrum Disorder (FASD) Center for Excellence	Form and Instruction	New	Attachments A-J
187958	The Center for Mental Health Services (CMHS) Customer Satisfaction Survey	Form and Instruction	New	CMHS-Survey
186976	Customer Feedback Survey on SAMHSA/OAS Publication: Short Report Series: The NSDUH Report, The DASIS Report, The DAWN Report	Form and Instruction	New	Short Report Satisfaction Survey
184812	SAMHSA/OAS Publication: National Directory of Drug and Alcohol Abuse Treatment Programs, 2008	Form and Instruction	New	Survey
183712	CSAP Customer Satisfaction Survey	Form and Instruction	New	Survey

ICR Details

OMB Control No: 0930-0197	ICR Reference No: 200710-0930-001
Status: Historical Active	Previous ICR Reference No: 200708-0930-006
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Voluntary Customer Satisfaction Surveys to Implement Executive Order 12862 in the Substance Abuse and Mental Health Services Administration (SAMHSA)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/25/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/19/2007
Terms of Clearance: Approved consistent with previous terms of clearance and procedures for customer satisfaction generic clearances across the government; HHS/SAMHSA will provide each survey for OMB review, along with a brief justification, burden estimate and description of any statistical methods and any planned remuneration. SAMHSA must receive explicit OMB approval prior to beginning any collections under this generic clearance. Reviews will generally be accomplished within 10 days.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2011	36 Months From Approved	01/31/2008
Responses	90,000	0	30,150
Time Burden (Hours)	23,063	0	15,225
Cost Burden (Dollars)	0	0	0

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Abstract: SAMHSA provides significant directly to the public, including treatment providers and State substance abuse agencies, through a range of mechanisms, including publications, technical assistance and web sites. Many of these services are focused on information dissemination activities. The purpose of this submission is to obtain generic approval for satisfaction surveys of our customers.

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Authorizing Statute(s): US Code: 5 USC 501 Name of Law: SAMHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 29340	05/25/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 43290	08/03/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 15

table that charts list of burden

IC Title	Form No.	Form Name
CMHS-GPRA Satisfaction of Technical Assistance Survey	Screen Shots, Attachment A - Online User's Survey	Screen Shots ,   Attachment A - Online User's Survey
CSAP Customer Satisfaction Survey	Survey	Survey
Child, Adolescent and Family Branch New Community Technical Assistance Visit Survey	Survey and Letters	Survey and Letters
Co-Occurring Disorders Integration and Innovation (CODI)	Formative Survey, Satisfaction Survey, Impact Survey, Formative Survey, LC Survey, Satisfaction Survey	Formative Survey ,   Satisfaction Survey ,   Impact Survey ,   LC Survey ,   Satisfaction Survey ,   Formative Survey
Customer Feedback Survey on SAMHSA/OAS Publication: Short Report Series: The NSDUH Report, The DASIS Report, The DAWN Report	Short Report Satisfaction Survey	Short Report Satisfaction Survey
End-of Email Survey	End-of Email Survey	End-of Email Survey
Fetal Alcohol Spectrum Disorder (FASD) Center for Excellence	Forms	Attachments A-J
Pilot Testing in Opioid Treatment Programs (OTPs) of Modular Survey with OTP-Speicfic Questions	Modular Survey - OTP Questions	Modular Survey - OTP Questions
Recovery to Pratice Resource Center TA and Webinar Evaluation Form	Webinar Evaluation Form, TA Evaluation Form	TA Evaluation Form ,   Webinar Evaluation Form
SAMHSA/OAS Publication: National Directory of Drug and Alcohol Abuse Treatment Programs, 2008	Survey	Survey
Shared Decision-Making in Mental Health Decision Support Tools	Survey #1 Consumer View of Workbook, Survey #2 Provider View of Workbook, Survey #3 Consumer View of Decision Aid, Survey #4 Provider View of Decision Aid	Survey #1 Consumer View of Workbook ,   Survey #2 Provider View of Workbook ,   Survey #3 Consumer View of Decision Aid ,   Survey #4 Provider View of Decision Aid
Suicide Prevention Assessment and Resource Kits (SPARK)	User Feedback Form	User Feedback Form
The Center for Mental Health Services (CMHS) Customer Satisfaction Survey	CMHS-Survey	CMHS-Survey
The Grant Applicant and the The Grant Reviewer Surveys	Grant Applicant Survey, Grant Reviewer Survey	Grant Applicant Survey ,   Grant Reviewer Survey
The Modular Survey on Consumer Perceptions of Care - CSAT	Modular Survey	Modular Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	90,000	30,150	0	59,850	0	0
Annual Time Burden (Hours)	23,063	15,225	0	7,838	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a program change increase of 7,838 hours due to greater anticipated use of customer satisfaction surveys.

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Annual Cost to Federal Government: $2,367,015

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/19/2007

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