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

Forms and Documents

Document Name	Status
Form Formative Survey Co-Occurring Disorders Integration and Innovation (CODI) Form and Instruction	New
Form End-of Email Surve End-of Email Survey Form	New
Form Survey and Letters Child, Adolescent and Family Branch New Community Technical Assistance Visit Survey Form	New
Form Survey #1 Consumer Shared Decision-Making in Mental Health Decision Support Tools Form and Instruction	New
Form TA Evaluation Form Recovery to Pratice Resource Center TA and Webinar Evaluation Form Form and Instruction	New
Form Modular Survey - O Pilot Testing in Opioid Treatment Programs (OTPs) of Modular Survey with OTP-Speicfic Questions Form and Instruction	New
Form User Feedback Form Suicide Prevention Assessment and Resource Kits (SPARK) Form and Instruction	New
Form Screen Shots CMHS-GPRA Satisfaction of Technical Assistance Survey Form and Instruction	New
Form Grant Applicant Su The Grant Applicant and the The Grant Reviewer Surveys Form and Instruction	New
Form Modular Survey The Modular Survey on Consumer Perceptions of Care - CSAT Form and Instruction	New
Form Forms Fetal Alcohol Spectrum Disorder (FASD) Center for Excellence Form and Instruction	New
Form CMHS-Survey The Center for Mental Health Services (CMHS) Customer Satisfaction Survey Form and Instruction	New
Form Short Report Satis Customer Feedback Survey on SAMHSA/OAS Publication: Short Report Series: The NSDUH Report, The DASIS Report, The DAWN Report Form and Instruction	New
Form Survey SAMHSA/OAS Publication: National Directory of Drug and Alcohol Abuse Treatment Programs, 2008 Form and Instruction	New
Form Survey CSAP Customer Satisfaction Survey Form and Instruction	New
0197-07-SS.doc Supporting Statement B	2007-10-15
0197-07-SS.doc Supporting Statement A	2007-10-15

IC Document Collections

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

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
	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.

	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

IC Title	Form No.	Form Name
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
The Modular Survey on Consumer Perceptions of Care - CSAT	Modular Survey	Modular Survey
End-of Email Survey	End-of Email Survey	End-of Email Survey
The Center for Mental Health Services (CMHS) Customer Satisfaction Survey	CMHS-Survey	CMHS-Survey
SAMHSA/OAS Publication: National Directory of Drug and Alcohol Abuse Treatment Programs, 2008	Survey	Survey
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 ,   Satisfaction Survey ,   Formative Survey ,   LC Survey
The Grant Applicant and the The Grant Reviewer Surveys	Grant Applicant Survey, Grant Reviewer Survey	Grant Applicant Survey ,   Grant Reviewer Survey
CMHS-GPRA Satisfaction of Technical Assistance Survey	Screen Shots, Attachment A - Online User's Survey	Screen Shots ,   Attachment A - Online User's Survey
Child, Adolescent and Family Branch New Community Technical Assistance Visit Survey	Survey and Letters	Survey and Letters
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
Recovery to Pratice Resource Center TA and Webinar Evaluation Form	Webinar Evaluation Form, TA Evaluation Form	TA Evaluation Form ,   Webinar Evaluation Form
CSAP Customer Satisfaction Survey	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

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ICR Summary 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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