Tree Testing the SAMHSA Store (https://store.samhsa.gov/)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:

Documents and Forms

Document Name Document Type
0990-0379_Tree Testing the SAMHSA Store v3 080117 RLM.docx Other-survey
0990-0379 Memo- SAMHSA Stores Tree Test 072517 RLM.docx Memo IC Document

Information Collection (IC) Details

IC Title:	Tree Testing the SAMHSA Store (https://store.samhsa.gov/)	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
Other-survey			0990-0379_Tree Testing the SAMHSA Store v3 080117 RLM.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Memo	0990-0379 Memo- SAMHSA Stores Tree Test 072517 RLM.docx	08/01/2017

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