Coaching Satisfaction Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 Coaching Satisfact Coaching Satisfaction Survey Form and Instruction
Coaching Satisfact Coaching Satisfaction Survey Contractor Coaching Satisfaction Survey Attachment 1, 6-25-13.doc Form and Instruction
Trans.Let-11-2013.doc Transmittal Memo IC Document
Contractor Coaching Satisfaction Survey, 6-25-13.doc Justification IC Document

Information Collection (IC) Details

IC Title:	Coaching Satisfaction Survey	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	Coaching Satisfaction Survey	Coaching Satisfaction Survey	Contractor Coaching Satisfaction Survey Attachment 1, 6-25-13.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	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	20	0	0	0	0	0
Annual IC Time Burden (Hours)	7	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Transmittal Memo	Trans.Let-11-2013.doc	07/18/2013
Justification	Contractor Coaching Satisfaction Survey, 6-25-13.doc	07/18/2013

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