The Center for Mental Health Services (CMHS) Customer Satisfaction Survey

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form CMHS-Survey The Center for Mental Health Services (CMHS) Customer Satisfaction Survey Form and Instruction
CMHS-Survey CMHS-Survey CMHS Customer Survey 2008.doc Form and Instruction
CMHS Customer Survey OMB Justification 2008.doc Justification IC Document
OMBTransLet4-2008.wpd Memo IC Document

Information Collection (IC) Details

IC Title:	The Center for Mental Health Services (CMHS) Customer Satisfaction Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMHS-Survey	CMHS-Survey	CMHS Customer Survey 2008.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	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	150	0	0	0	0	0
Annual IC Time Burden (Hours)	10	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	CMHS Customer Survey OMB Justification 2008.doc	10/28/2008
Memo	OMBTransLet4-2008.wpd	10/28/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.