CMHS-GPRA Satisfaction of Technical Assistance 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⚠️ Notice: This information collection may be referencing outdated material.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 Screen Shots CMHS-GPRA Satisfaction of Technical Assistance Survey Form and Instruction
Screen Shots Screen Shots CMHS-TRAC TA Annual Survey Final Screen Shot 7-30-09.doc Form and Instruction
Attachment A - Onl Attachment A - Online User's Survey CMHS-TRAC TA Annual Survey Final 7-30-09.doc Form and Instruction
CMHS-TRAC TA Survey OMB Request Final 7-30-09.doc Justification IC Document
OMBTransLet8-2009.wpd Memo IC Document

Information Collection (IC) Details

IC Title:	CMHS-GPRA Satisfaction of Technical Assistance 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	Screen Shots	Screen Shots	CMHS-TRAC TA Annual Survey Final Screen Shot 7-30-09.doc		Yes	Yes	Paper Only
Form and Instruction	Attachment A - Online User's Survey	Attachment A - Online User's Survey	CMHS-TRAC TA Annual Survey Final 7-30-09.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	800	0	0	0	0	0
Annual IC Time Burden (Hours)	128	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-TRAC TA Survey OMB Request Final 7-30-09.doc	07/30/2009
Memo	OMBTransLet8-2009.wpd	07/30/2009

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