Annual Generalized TA 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⚠️ Notice: This information collection may be referencing outdated material.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 Modified TA Networ Annual Generalized TA Survey Form and Instruction
Modified TA Networ Modified TA Network Satisfaction Survey A-Modified TA Network Satisfaction Survey Seeking Approval_Table.docx Form and Instruction
TA Network Supporting Statement CQI Final.docx Justification-SS IC Document
Trans.Let-5-2015.doc Justification Letter IC Document

Information Collection (IC) Details

IC Title:	Annual Generalized TA 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	Modified TA Network Satisfaction Survey	Modified TA Network Satisfaction Survey	A-Modified TA Network Satisfaction Survey Seeking Approval_Table.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	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	200	200
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification-SS	TA Network Supporting Statement CQI Final.docx	02/12/2015
Justification Letter	Trans.Let-5-2015.doc	02/12/2015

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