Feedback Publication: OTP: 2013 State Profile

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⚠️ Notice: This information collection may be referencing outdated material.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 OTP Report Survey Feedback Publication: OTP: 2013 State Profile Form and Instruction
OTP Report Survey OTP Report Survey OTPReportSurvey.pdf Form and Instruction
OMBclearance-OTPsurvey130613.docx Justification IC Document
RecruitmentEmail130613.docx Recruitment Email IC Document
Trans.Let-10-2013.doc Transmittal Letter IC Document

Information Collection (IC) Details

IC Title:	Feedback Publication: OTP: 2013 State Profile	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	OTP Report Survey	OTP Report Survey	OTPReportSurvey.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 99	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 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	99	0	0	0	0	0
Annual IC Time Burden (Hours)	17	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	OMBclearance-OTPsurvey130613.docx	06/13/2013
Recruitment Email	RecruitmentEmail130613.docx	06/13/2013
Transmittal Letter	Trans.Let-10-2013.doc	06/13/2013

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