Medication-Assisted Treatment (MAT) Application

Voluntary Customer Satisfaction Surveys to Implement Executive Order 12862 in the Substance Abuse and Mental Health Services Administration (SAMHSA)

OMB: 0930-0197

IC ID: 220719

Information Collection (IC) Details

View Information Collection (IC)

Medication-Assisted Treatment (MAT) Application
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction MAT APP MAT APP Attachment 1_MAT App Feedback Survey_03 21 16.KHCdocx.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

216 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 216 0 216 0 0 0
Annual IC Time Burden (Hours) 11 0 11 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement MAT App User Feedback Survey OMB Request 03-21-16.KHC.doc 03/22/2016
Transmittal Letter Trans.Let-9-2016.doc 03/22/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy