Voluntary Customer Satisfaction Surveys to Implement Executive Order 12862 in the Substance Abuse and Mental Health Services Administration (SAMHSA)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Coaching Satisfact Coaching Satisfaction Survey	Form and Instruction	New	Available
Form OTP Report Survey Feedback Publication: OTP: 2013 State Profile	Form and Instruction	New	Available
Form Feedback Survey Project EVOLVE Feedback Survey	Form and Instruction	New	Available
Form TA Partnership Sur TA CMHS Partnership	Form and Instruction	New	Available
Form Follow-Up Survey TA CSAP Prevention Fellowship Program	Form and Instruction	New	Available
Form Data Users Satisfa Post Behavioral Health Data Users Conference Satisfaction Survey	Form	New	Available
Form Attachment A Training and Technical Assistance Performance Measures	Form and Instruction	New	Available
Form Contractor Attachm Child, Adolescent and Family Branch Technical Assistance Enterprise Feedback Survey	Form and Instruction	New	Available
Form Follow-Up Learning TA-Learning Event Feedback Survey	Form and Instruction	New	Available
Form Mid-Course Feedbac Mid-Course technical Assistance Feedback Form	Form and Instruction	New	Available
Form Surveys Child Adolescent and Family Branch Technical Assistance Feedback Surveys	Form and Instruction	New	Available
Trans.Let-Zero Burden.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2011-03-24	Available
0197-11-SS.doc	Supporting Statement A	Uploaded 2011-03-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207899	Coaching Satisfaction Survey	Form and Instruction	New
207353	Feedback Publication: OTP: 2013 State Profile	Form and Instruction	New
206910	Project EVOLVE Feedback Survey	Form and Instruction	New
205153	TA CMHS Partnership	Form and Instruction	New
204313	TA CSAP Prevention Fellowship Program	Form and Instruction	New
203873	Post Behavioral Health Data Users Conference Satisfaction Survey	Form	New
203454	Training and Technical Assistance Performance Measures	Form and Instruction	New
203034	Child, Adolescent and Family Branch Technical Assistance Enterprise Feedback Survey	Form and Instruction	New
202287	TA-Learning Event Feedback Survey	Form and Instruction	New
202151	Mid-Course technical Assistance Feedback Form	Form and Instruction	New
197384	Child Adolescent and Family Branch Technical Assistance Feedback Surveys	Form and Instruction	New

ICR Details

OMB Control No: 0930-0197	ICR Reference No: 201103-0930-003
Status: Historical Active	Previous ICR Reference No: 201101-0930-003
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Voluntary Customer Satisfaction Surveys to Implement Executive Order 12862 in the Substance Abuse and Mental Health Services Administration (SAMHSA)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/13/2011
	Date Received in OIRA: 03/26/2011
Terms of Clearance: Approved consistent with previous terms of clearance and procedures for customer satisfaction generic clearances across the government; HHS/SAMHSA will provide each survey for OMB review, along with a brief justification, burden estimate and description of any statistical methods and any planned remuneration. Data and results are for internal agency use only and will not be released externally. SAMHSA must receive explicit OMB approval prior to beginning any collections under this generic clearance. Reviews will generally be accomplished within 10 days.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2014	03/31/2014	03/31/2014
Responses	90,000	0	90,000
Time Burden (Hours)	23,063	0	23,063
Cost Burden (Dollars)	0	0	0

---

Abstract: SAMHSA provides significant services directly to the public, including treatment providers and State substance abuse agencies, through a range of mechanisms, including publications, technical assistance and web sites. Many of these services are focused on information dissemination activities. The purpose of this submission is to obtain generic approval for satisfaction surveys of our customers.

---

Authorizing Statute(s): US Code: 42 USC 501 Name of Law: SAMHSA
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 39533	07/09/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 58392	09/24/2010
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 11

table that charts list of burden

IC Title	Form No.	Form Name
Post Behavioral Health Data Users Conference Satisfaction Survey	Data Users Satisfaction Survey	Data Users Satisfaction Survey
TA CSAP Prevention Fellowship Program	Follow-Up Survey, Fellowship Survey	Follow-Up Survey ,   Fellowship Survey
Child, Adolescent and Family Branch Technical Assistance Enterprise Feedback Survey	Contractor Attachments	Contractor Attachments
Child Adolescent and Family Branch Technical Assistance Feedback Surveys	Surveys, Surveys	Surveys ,   Surveys
Mid-Course technical Assistance Feedback Form	Mid-Course Feedback Form	Mid-Course Feedback Form
TA CMHS Partnership	TA Partnership Survey	TA Partnership Survey
Coaching Satisfaction Survey	Coaching Satisfaction Survey	Coaching Satisfaction Survey
Feedback Publication: OTP: 2013 State Profile	OTP Report Survey	OTP Report Survey
TA-Learning Event Feedback Survey	On-Site Learning Event Feedback Form, Follow-Up Learning Event Feedback Form	Follow-Up Learning Event Feedback Form ,   On-Site Learning Event Feedback Form
Training and Technical Assistance Performance Measures	Attachment A	Performance Measures
Project EVOLVE Feedback Survey	Feedback Survey	Feedback Survey

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	90,000	90,000	0	0	0	0
Annual Time Burden (Hours)	23,063	23,063	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $2,367,015

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/25/2011

---