TA-Learning Event Feedback 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⚠️ Notice: This information collection may be referencing outdated material.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 Follow-Up Learning TA-Learning Event Feedback Survey Form and Instruction
On-Site Learning E On-Site Learning Event Feedback Form Attachment 1 On-Site Learning Event Feedback Form 5-24-12.docx Form and Instruction
Follow-Up Learning Follow-Up Learning Event Feedback Form Attachment 2 Follow-Up Learning Event Feedback Form 5-24-12.docx Form and Instruction
Trans.Let-3-2012.doc Trans Letter IC Document
TA Partnership Customer Satisfaction Survey, 5-11-12.pdf Justification IC Document

Information Collection (IC) Details

IC Title:	TA-Learning Event Feedback 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 and Instruction	Follow-Up Learning Event Feedback Form	Follow-Up Learning Event Feedback Form	Attachment 2 Follow-Up Learning Event Feedback Form 5-24-12.docx		Yes	Yes	Fillable Printable
Form and Instruction	On-Site Learning Event Feedback Form	On-Site Learning Event Feedback Form	Attachment 1 On-Site Learning Event Feedback Form 5-24-12.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 190	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 Agency Discretion
Annual Number of Responses for this IC	190	190
Annual IC Time Burden (Hours)	29	29
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Trans Letter	Trans.Let-3-2012.doc	05/15/2012
Justification	TA Partnership Customer Satisfaction Survey, 5-11-12.pdf	05/15/2012

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