Information Collection

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

IC 187958 under ICR 200710-0930-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.