National Resource for MH Promotion and Youth Violence Prevention

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⚠️ Notice: This information collection may be referencing outdated material.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 NRC Online Feedbac National Resource for MH Promotion and Youth Violence Prevention Form and Instruction
NRC Online Feedbac NRC Online Feedback Form Attachment 1_NRC Online Feedback Form_10.13.2016.doc Form and Instruction
NRC Online Module NRC Online Module Feedback Form Attachment 2_NRC Online Module Feedback Form_10.13.2016.doc Form and Instruction
Onsite In Person T Onsite In Person Training Feedback Form Attachment 3_Onsite In Person Training Feedback Form_10.13.2016.doc Form and Instruction
Offsite In Person Offsite In Person Training Feedback Form Attachment 4_Offsite In Person Training Feedback Form_10.13.2016.doc Form and Instruction
Public Website and Public Website and TA Gateway Feedback Forms Attachment 5_Public Website and TA Gateway Feedback Forms_10.13.2016.doc Form and Instruction
TA Customer Satisf TA Customer Satisfaction Feedback Form Attachment 6_TA Customer Satisfaction Feedback Form_10.13.2016.doc Form and Instruction
Youth Violence_Justification_10.18.2016.doc Justification IC Document
Trans.Let-10-2016.doc Transmittal Letter IC Document

Information Collection (IC) Details

IC Title:	National Resource for MH Promotion and Youth Violence Prevention	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NRC Online Feedback Form	NRC Online Feedback Form	Attachment 1_NRC Online Feedback Form_10.13.2016.doc	Yes	Yes	Fillable Fileable
Form and Instruction	NRC Online Module Feedback Form	NRC Online Module Feedback Form	Attachment 2_NRC Online Module Feedback Form_10.13.2016.doc	Yes	Yes	Fillable Fileable
Form and Instruction	Onsite In Person Training Feedback Form	Onsite In Person Training Feedback Form	Attachment 3_Onsite In Person Training Feedback Form_10.13.2016.doc	Yes	Yes	Fillable Fileable
Form and Instruction	Offsite In Person Training Feedback Form	Offsite In Person Training Feedback Form	Attachment 4_Offsite In Person Training Feedback Form_10.13.2016.doc	Yes	Yes	Fillable Fileable
Form and Instruction	Public Website and TA Gateway Feedback Forms	Public Website and TA Gateway Feedback Forms	Attachment 5_Public Website and TA Gateway Feedback Forms_10.13.2016.doc	Yes	Yes	Fillable Fileable
Form and Instruction	TA Customer Satisfaction Feedback Form	TA Customer Satisfaction Feedback Form	Attachment 6_TA Customer Satisfaction Feedback Form_10.13.2016.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,213	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	1,213	1,213
Annual IC Time Burden (Hours)	107	107
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	Youth Violence_Justification_10.18.2016.doc	10/20/2016
Transmittal Letter	Trans.Let-10-2016.doc	10/20/2016

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