GDTA Learning Community

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⚠️ Notice: This information collection may be referencing outdated material.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 Survey GDTA Learning Community Form and Instruction
Survey Survey GDTA LC Attachment A 20151123.docx Form and Instruction
GDTA LC Attachment B 20151123.docx Email Letters IC Document
GDTA LC Attachment C 20150911.docx Screen Shots IC Document
SAMHSA Learning Community Satisfaction Survey 20151130.docx Supporting Statement IC Document
Trans.Let-8-2015.doc Transmittal Letter IC Document

Information Collection (IC) Details

IC Title:	GDTA Learning Community	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	Survey	Survey	GDTA LC Attachment A 20151123.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	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)	85	85
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Email Letters	GDTA LC Attachment B 20151123.docx	12/02/2015
Screen Shots	GDTA LC Attachment C 20150911.docx	12/02/2015
Supporting Statement	SAMHSA Learning Community Satisfaction Survey 20151130.docx	12/02/2015
Transmittal Letter	Trans.Let-8-2015.doc	12/02/2015

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