TA CSAP Prevention Fellowship Program

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⚠️ Notice: This information collection may be referencing outdated material.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 Survey TA CSAP Prevention Fellowship Program Form and Instruction
Fellowship Survey Fellowship Survey Annual Fellowship Survey_8 21_final.docx Form and Instruction
Follow-Up Survey Follow-Up Survey Alumni Follow-Up Survey_8 21_final.docx Form and Instruction
PFP_OMB_Supporting_Statement 9 25 12.doc Justification (SS) IC Document
Trans Let-7-2012.doc Memo IC Document

Information Collection (IC) Details

IC Title:	TA CSAP Prevention Fellowship Program	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 Survey	Follow-Up Survey	Alumni Follow-Up Survey_8 21_final.docx		Yes	Yes	Fillable Printable
Form and Instruction	Fellowship Survey	Fellowship Survey	Annual Fellowship Survey_8 21_final.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 64	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	64	64
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification (SS)	PFP_OMB_Supporting_Statement 9 25 12.doc	10/25/2012
Memo	Trans Let-7-2012.doc	10/25/2012

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