Co-Occurring Disorders Integration and Innovation (CODI)

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⚠️ Notice: This information collection may be referencing outdated material.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 Formative Survey Co-Occurring Disorders Integration and Innovation (CODI) Form and Instruction
Formative Survey Formative Survey Appendix A-Formative Survey 10-6-10 sg sts.doc Form and Instruction
Satisfaction Surve Satisfaction Survey Appendix B-Satisfaction Survey 10-6-10 sg sts.doc Form and Instruction
Impact Survey Impact Survey Appendix C-Impact Survey 9-3-10 sg sts.doc Form and Instruction
LC Survey LC Survey Appendix C-LC Survey 11-3-10.docx Form and Instruction
Satisfaction Surve Satisfaction Survey Appendix B-Satisfaction Survey 11-1-10.docx Form and Instruction
Formative Survey Formative Survey Appendix A-Formative Survey 11-1-2010.docx Form and Instruction
CODI OMB Justification Document sg sts 20100916.doc Justification IC Document
Trans.Let-15-2010.doc Memo IC Document
CODI OMB Justification Document 11-3-2010.docx Justification IC Document

Information Collection (IC) Details

IC Title:	Co-Occurring Disorders Integration and Innovation (CODI)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Formative Survey	Formative Survey	Appendix A-Formative Survey 10-6-10 sg sts.doc	Yes	Yes	Paper Only
Form and Instruction	Satisfaction Survey	Satisfaction Survey	Appendix B-Satisfaction Survey 10-6-10 sg sts.doc	Yes	Yes	Paper Only
Form and Instruction	Impact Survey	Impact Survey	Appendix C-Impact Survey 9-3-10 sg sts.doc	Yes	Yes	Paper Only
Form and Instruction	Satisfaction Survey	Satisfaction Survey	Appendix B-Satisfaction Survey 11-1-10.docx	Yes	Yes	Paper Only
Form and Instruction	Formative Survey	Formative Survey	Appendix A-Formative Survey 11-1-2010.docx	Yes	Yes	Paper Only
Form and Instruction	LC Survey	LC Survey	Appendix C-LC Survey 11-3-10.docx	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,985	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	2,985	0	0	0	0	0
Annual IC Time Burden (Hours)	241	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	CODI OMB Justification Document sg sts 20100916.doc	10/08/2010
Memo	Trans.Let-15-2010.doc	10/08/2010
Justification	CODI OMB Justification Document 11-3-2010.docx	11/04/2010

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