Information Collection

GDTA Learning Community

IC 219144 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⚠️ Notice: This information collection may be referencing outdated material.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 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

IC Title:

GDTA Learning Community

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.