SBIRT Organizational Readiness and 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⚠️ Notice: This information collection may be referencing outdated material.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 SBIRT Organization SBIRT Organizational Readiness and Satisfaction Survey Form and Instruction
SBIRT Organization SBIRT Organizational Readiness and Satisfaction Survey Survey SBIRT Organizational Readiness and Satisfaction Survey 2-5-15.docx Form and Instruction
SS SBIRT Organizational Readiness and Satisfaction Survey_2_5_15.doc Justification IC Document
Trans.Let-4-2014.doc Letter IC Document

Information Collection (IC) Details

IC Title:	SBIRT Organizational Readiness and 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	SBIRT Organizational Readiness and Satisfaction Su	SBIRT Organizational Readiness and Satisfaction Survey	Survey SBIRT Organizational Readiness and Satisfaction Survey 2-5-15.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 410	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	410	410
Annual IC Time Burden (Hours)	62	62
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	SS SBIRT Organizational Readiness and Satisfaction Survey_2_5_15.doc	02/09/2015
Letter	Trans.Let-4-2014.doc	02/09/2015

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