National Recovery Month's Public Serive Announcement

Pretesting of Substance Abuse Prevention and Treatment and Mental Health Services Communications Messages

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0196 can be found here:

Documents and Forms

Document Name Document Type
Form Screener National Recovery Month's Public Serive Announcement Form and Instruction
Screener Screener ATTACHMENT A - Screening Questionnaire.docx Form and Instruction
Consent form-guide Consent form-guide-scripts ATTACHMENT B - Consent form-guide-scripts.docx Form and Instruction
CSAT Focus Groups - OMB Supporting Statement.doc Justification IC Document
TransLet-2.doc Letter IC Document

Information Collection (IC) Details

IC Title:	National Recovery Month's Public Serive Announcement	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	Screener	Screener	ATTACHMENT A - Screening Questionnaire.docx		Yes	Yes	Fillable Fileable
Form and Instruction	Consent form-guide-scripts	Consent form-guide-scripts	ATTACHMENT B - Consent form-guide-scripts.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	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	40	40
Annual IC Time Burden (Hours)	51	51
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	CSAT Focus Groups - OMB Supporting Statement.doc	11/16/2015
Letter	TransLet-2.doc	11/16/2015

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