Fetal Alcohol Spectrum Disorder (FASD) Center for Excellence

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

OMB: 0930-0197

IC ID: 188132

Information Collection (IC) Details

View Information Collection (IC)

Fetal Alcohol Spectrum Disorder (FASD) Center for Excellence
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Forms Attachments A-J ATTACHMENT A-J.doc Yes Yes Paper Only

Health Public Health Monitoring

 

5,405 0
   
State, Local, and Tribal Governments
 
   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 6,685 0 0 0 0 0
Annual IC Time Burden (Hours) 601 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement FASD- Training &TA - Supporting Statement.doc 02/18/2009
Justification Letter OMBTransLet5-2009.wpd 02/18/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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