Memo

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Substance Abuse and Mental

Health Services Administration

Rockville, MD 20857

DATE: August 27, 2010

FROM: Reports Clearance Officer, SAMHSA

TO: Chief, Human Resources and Housing Branch

Office of Information and Regulatory Affairs, OMB

ATTN: Chad Lallemand

Through: Reports Clearance Officer, DHHS ____

SUBJECT: Child, Adolescent and Family Branch New Community Technical Assistance Visit Survey (OMB No. 0930-0197)

The attached materials are provided in support of our request for approval of a customer satisfaction feedback survey under SAMHSA’s generic approval for “Voluntary Customer Satisfaction Surveys to Implement Executive Order 12862 in the Substance Abuse and Mental Health Services Administration.”

This is the 13th submission under that approval and will impose an estimated annual average total burden of 30 hours, which would bring the total currently approved burden under this clearance to 15,225 hours for this data collection. The current total burden hours in the OMB inventory for the Customer Satisfaction Survey (OMB No. 0930-0197) is 23,063.

We look forward to receiving your feedback so that implementation may proceed.

Summer King

Attachments:

Data Collection Proposal and Survey Materials