Pilot Testing in Opioid Treatment Programs (OTPs) of Modular Survey with OTP-Speicfic Questions

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⚠️ Notice: This information collection may be referencing outdated material.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 - O Pilot Testing in Opioid Treatment Programs (OTPs) of Modular Survey with OTP-Speicfic Questions Form and Instruction
Modular Survey - O Modular Survey - OTP Questions Attachment 1 - Modular Survey Instrument with OTP Questions 12-18-09 ag.doc Form and Instruction
OTP Modular Survey OMB 12-18-09 ag.doc Justification IC Document
OMBTransLet10-2009.wpd Letter IC Document

Information Collection (IC) Details

IC Title:	Pilot Testing in Opioid Treatment Programs (OTPs) of Modular Survey with OTP-Speicfic Questions	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 - OTP Questions	Modular Survey - OTP Questions	Attachment 1 - Modular Survey Instrument with OTP Questions 12-18-09 ag.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,200	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	1,200	0	0	0	0	0
Annual IC Time Burden (Hours)	300	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	OTP Modular Survey OMB 12-18-09 ag.doc	01/07/2010
Letter	OMBTransLet10-2009.wpd	01/07/2010

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