Impact of Training and Technical Assistance Tool

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⚠️ Notice: This information collection may be referencing outdated material.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 TTA Tool Impact of Training and Technical Assistance Tool Form and Instruction
TTA Tool TTA Tool Attachment 1-TA Network_QA Survey.docx Form and Instruction
Attachment 3-IRB Determination Letter.pdf IRB IC Document
TA Network Supporting Statement CQI Final.docx Supporting Statement IC Document
Trans.Let-3-2014.doc Transmittal Letter IC Document

Information Collection (IC) Details

IC Title:	Impact of Training and Technical Assistance Tool	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	TTA Tool	TTA Tool	Attachment 1-TA Network_QA Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	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	800	800
Annual IC Time Burden (Hours)	136	136
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
IRB	Attachment 3-IRB Determination Letter.pdf	11/04/2014
Supporting Statement	TA Network Supporting Statement CQI Final.docx	11/04/2014
Transmittal Letter	Trans.Let-3-2014.doc	11/04/2014

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