Child, Adolescent and Family Branch New Community Technical Assistance Visit 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⚠️ Notice: This information collection may be referencing outdated material.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 Survey and Letters Child, Adolescent and Family Branch New Community Technical Assistance Visit Survey Form
Survey and Letters Survey and Letters NCTAV Survey List of Attachments.docx Form
Contractor NCTAV Satisfaction Survey, 8-27-10.doc Justification IC Document
OMBTransLet13-2010.wpd Memo IC Document
Contractor NCTAV Satisfaction Survey, 9-17-10.doc Revised Justification IC Document

Information Collection (IC) Details

IC Title:	Child, Adolescent and Family Branch New Community Technical Assistance Visit 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	Survey and Letters	Survey and Letters	NCTAV Survey List of Attachments.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180	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	180	0	0	0	0	0
Annual IC Time Burden (Hours)	30	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	Contractor NCTAV Satisfaction Survey, 8-27-10.doc	08/27/2010
Memo	OMBTransLet13-2010.wpd	08/27/2010
Revised Justification	Contractor NCTAV Satisfaction Survey, 9-17-10.doc	09/17/2010

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