The Modular Survey on Consumer Perceptions of Care - CSAT

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⚠️ Notice: This information collection may be referencing outdated material.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 Modular Survey The Modular Survey on Consumer Perceptions of Care - CSAT Form and Instruction
Modular Survey Modular Survey Modular Survey OMB Attachment 1 - Modular Survey Instrument 6-15-09.doc Form and Instruction
OMBTransLet5-2009.wpd Justification Memo IC Document
Modular Survey OMB Update 6-15-09.doc Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	The Modular Survey on Consumer Perceptions of Care - CSAT	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	Modular Survey	Modular Survey	Modular Survey OMB Attachment 1 - Modular Survey Instrument 6-15-09.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,650	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	2,650	0	0	0	0	0
Annual IC Time Burden (Hours)	450	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Justification Memo	OMBTransLet5-2009.wpd	06/15/2009
Supporting Statement	Modular Survey OMB Update 6-15-09.doc	06/15/2009

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