Information Collection

SBIRT Organizational Readiness and Satisfaction Survey

IC 214917 under ICR 201406-0930-006 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
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

IC Title:

SBIRT Organizational Readiness and Satisfaction Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.