Mid-Course technical Assistance Feedback Form

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

OMB: 0930-0197

IC ID: 202151

Information Collection (IC) Details

View Information Collection (IC)

Mid-Course technical Assistance Feedback Form
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Mid-Course Feedback Form Mid-Course Feedback Form Attachment 1 Mid Course Feedback Form.docx Yes Yes Paper Only

Health Illness Prevention

 

100 0
   
State, Local, and Tribal Governments
 
   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 100 0 0 0 0 0
Annual IC Time Burden (Hours) 20 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Justification Technical Assistance Enterprise, Mid-Course Feedback Form, 5.4.12.doc 05/04/2012
Transmit Letter Trans.Let-2-2012.doc 05/04/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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