Child, Adolescent and Family Branch Technical Assistance Enterprise 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⚠️ Notice: This information collection may be referencing outdated material.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 Contractor Attachm Child, Adolescent and Family Branch Technical Assistance Enterprise Feedback Survey Form and Instruction
Contractor Attachm Contractor Attachments Contractor Attachments, 6-8-12.docx Form and Instruction
Contractor Surveys OMB Request, 6-11-12.doc Justification IC Document
Trans.Let-4-2012.doc Letter IC Document

Information Collection (IC) Details

IC Title:	Child, Adolescent and Family Branch Technical Assistance Enterprise 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	Contractor Attachments	Contractor Attachments	Contractor Attachments, 6-8-12.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 626	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	626	626
Annual IC Time Burden (Hours)	104	104
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	Contractor Surveys OMB Request, 6-11-12.doc	06/11/2012
Letter	Trans.Let-4-2012.doc	06/11/2012

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