Child Adolescent and Family Branch Technical Assistance Feedback Surveys

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⚠️ Notice: This information collection may be referencing outdated material.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 Surveys Child Adolescent and Family Branch Technical Assistance Feedback Surveys Form and Instruction
Surveys Surveys Contractor Satisfaction Surveys List of Attachments, 3-8-11.pdf Form and Instruction
Surveys Surveys Contractor Satisfaction Surveys List of Attachments, 5-31-11.pdf Form and Instruction
Contractor Justification 3-8-11.doc Justification IC Document
Trans.Let-1-2011.doc Letter IC Document
Contractor Satisfaction Surveys, 5-31-11.pdf Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Child Adolescent and Family Branch Technical Assistance Feedback Surveys	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	Surveys	Surveys	Contractor Satisfaction Surveys List of Attachments, 3-8-11.pdf		Yes	Yes	Paper Only
Form and Instruction	Surveys	Surveys	Contractor Satisfaction Surveys List of Attachments, 5-31-11.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 880	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	880	0	0	0	0	0
Annual IC Time Burden (Hours)	126	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 Justification 3-8-11.doc	03/08/2011
Letter	Trans.Let-1-2011.doc	03/08/2011
Supporting Statement	Contractor Satisfaction Surveys, 5-31-11.pdf	05/31/2011

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