Knowledge Application Program Product

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⚠️ Notice: This information collection may be referencing outdated material.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 KAP Survey Knowledge Application Program Product Form and Instruction
KAP Survey KAP Survey KAP_Customer_Survey_10-28-15.docx Form and Instruction
KAP_OMB_Proposal_10-28-15.docx Justification IC Document
Trans.Let-6-2015.doc Transmittal Letter IC Document

Information Collection (IC) Details

IC Title:	Knowledge Application Program Product	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	KAP Survey	KAP Survey	KAP_Customer_Survey_10-28-15.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	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	500	500
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	KAP_OMB_Proposal_10-28-15.docx	10/29/2015
Transmittal Letter	Trans.Let-6-2015.doc	10/29/2015

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