Public Engagement Platform Surveys

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⚠️ Notice: This information collection may be referencing outdated material.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 Bulling Prevention Public Engagement Platform Surveys Form and Instruction
Bulling Prevention Bulling Prevention Survey Attachment 1_Bullying Prevention.docx Form and Instruction
Suicide Prevention Suicide Prevention Survey Attachment 2_Suicide Prevention.docx Form and Instruction
Contact Center Sur Contact Center Survey Attachment 3_contact center.docx Form and Instruction
Customer Feedback Surveys OMB Request 6-27-14.doc Justification IC Document
Trans.Let-1-2014.doc Transmittal Letter IC Document

Information Collection (IC) Details

IC Title:	Public Engagement Platform Surveys	Agency IC Tracking Number:	1

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	Bulling Prevention Survey	Bulling Prevention Survey	Attachment 1_Bullying Prevention.docx	Yes	Yes	Fillable Printable
Form and Instruction	Suicide Prevention Survey	Suicide Prevention Survey	Attachment 2_Suicide Prevention.docx	Yes	Yes	Fillable Printable
Form and Instruction	Contact Center Survey	Contact Center Survey	Attachment 3_contact center.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 888	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	888	888
Annual IC Time Burden (Hours)	57	57
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	Customer Feedback Surveys OMB Request 6-27-14.doc	06/30/2014
Transmittal Letter	Trans.Let-1-2014.doc	06/30/2014

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