Training and Technical Assistance Performance Measures

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⚠️ Notice: This information collection may be referencing outdated material.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 Attachment A Training and Technical Assistance Performance Measures Form and Instruction
Attachment A Performance Measures Attachment A Training and TA Performance Measures110929.docx Form and Instruction
705Attachment B Staff and Consultants Involved111004.docx Staff and Consultants Involved IC Document
705-12OMBTASupportingStatement_7.11.12.docx Justification IC Document
Trans.Let-5-2012.doc Letter/Memo IC Document

Information Collection (IC) Details

IC Title:	Training and Technical Assistance Performance Measures	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	Attachment A	Performance Measures	Attachment A Training and TA Performance Measures110929.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,694	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	4,694	4,694
Annual IC Time Burden (Hours)	389	389
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Staff and Consultants Involved	705Attachment B Staff and Consultants Involved111004.docx	07/12/2012
Justification	705-12OMBTASupportingStatement_7.11.12.docx	07/12/2012
Letter/Memo	Trans.Let-5-2012.doc	07/12/2012

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