National Recovery Month

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⚠️ Notice: This information collection may be referencing outdated material.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 Screening Question National Recovery Month Form and Instruction
Screening Question Screening Questionnaire 2016_7_21_ATTACHMENT A_2017 RM Recruiting and Screening Questionnaire.docx Form and Instruction
Moderator's Guide Moderator's Guide 2016_7_21_ATTACHMENT B_RM 2017 English Moderator's Guide.docx Form and Instruction
Consent Form Consent Form 2016_7_21_ATTACHMENT C_2017 RM Consent Form ENG.docx Form and Instruction
TransLet-7doc.doc Transmittal Letter IC Document
2016_7_25_CSAT RM Focus Groups - 2017 OMB Supporting Statement.doc Justification IC Document

Information Collection (IC) Details

IC Title:	National Recovery Month	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Screening Questionnaire	Screening Questionnaire	2016_7_21_ATTACHMENT A_2017 RM Recruiting and Screening Questionnaire.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Moderator's Guide	Moderator's Guide	2016_7_21_ATTACHMENT B_RM 2017 English Moderator's Guide.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Consent Form	Consent Form	2016_7_21_ATTACHMENT C_2017 RM Consent Form ENG.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

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	88	88
Annual IC Time Burden (Hours)	84	84
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Transmittal Letter	TransLet-7doc.doc	07/25/2016
Justification	2016_7_25_CSAT RM Focus Groups - 2017 OMB Supporting Statement.doc	07/25/2016

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