OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Project EVOLVE Feedback Survey

IC 206910 under ICR 201103-0930-003 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Feedback Survey Project EVOLVE Feedback Survey	Form and Instruction
Feedback Survey Feedback Survey SurveyMonkeyQuestions.jpg	Form and Instruction
SAMHSA Customer Satisfaction Survey-EVOLVE 6.13.13.docx Justification	IC Document
Trans.Let-8-2012.doc Letter	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Project EVOLVE Feedback Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Feedback Survey	Feedback Survey	SurveyMonkeyQuestions.jpg		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	700	0	0	0	0	0
Annual IC Time Burden (Hours)	56	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification	SAMHSA Customer Satisfaction Survey-EVOLVE 6.13.13.docx	05/13/2013
Letter	Trans.Let-8-2012.doc	05/13/2013

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