Suicide Prevention Assessment and Resource Kits (SPARK)

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⚠️ Notice: This information collection may be referencing outdated material.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 User Feedback Form Suicide Prevention Assessment and Resource Kits (SPARK) Form and Instruction
User Feedback Form User Feedback Form OMB Customer Satisfaction Survey Clearance Request_9-08-09.doc Form and Instruction
OMB_Invitation and other Correspondence with Respondents 9_8_09.doc Letters IC Document
SPARK-OMB Request Customer Satisfaction Survey_9-08-09.doc Justification IC Document
OMBTransLet9-2009.wpd Memo IC Document

Information Collection (IC) Details

IC Title:	Suicide Prevention Assessment and Resource Kits (SPARK)	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	User Feedback Form	User Feedback Form	OMB Customer Satisfaction Survey Clearance Request_9-08-09.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 700	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	700	0	0	0	0	0
Annual IC Time Burden (Hours)	175	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Letters	OMB_Invitation and other Correspondence with Respondents 9_8_09.doc	09/10/2009
Justification	SPARK-OMB Request Customer Satisfaction Survey_9-08-09.doc	09/10/2009
Memo	OMBTransLet9-2009.wpd	09/10/2009

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