TA CMHS Partnership

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⚠️ Notice: This information collection may be referencing outdated material.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 TA Partnership Sur TA CMHS Partnership Form and Instruction
TA Partnership Sur TA Partnership Survey TA Partnership Satisfaction Survey Attachment, 12-13-12.docx Form and Instruction
Trans.Let-8-2012.doc Transmittal Letter IC Document
TA Partnership Satisfaction Survey, 12-13-12.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	TA CMHS Partnership	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	TA Partnership Survey	TA Partnership Survey	TA Partnership Satisfaction Survey Attachment, 12-13-12.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 96	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	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	96	0	0	0	0	0
Annual IC Time Burden (Hours)	16	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Transmittal Letter	Trans.Let-8-2012.doc	12/13/2012
Supporting Statement	TA Partnership Satisfaction Survey, 12-13-12.docx	12/13/2012

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