Attachment 1: Provider Association Director Survey
OMB No. 0930-xxxx
Expiration Date: xx/xx/xx
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-xxxx. Public reporting burden for this collection of information is estimated to average 60 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 2-1057, Rockville, Maryland, 20857.
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The Addiction Technology Transfer Center Network (ATTC) is conducting a study on work force recruitment, retention and development as part of our annual contract with SAMHSA. We would like your help in identifying organizations that excel in any of the above three areas. The organizations you identify must provide substance abuse treatment services, but they do not have to be substance abuse specialty treatment agencies. They could be FQHCs, Community Mental Health Centers, or addiction specialty treatment programs or any other type of organization that provides addiction treatment or recovery services. The goal of this study is to identify best practices in workforce recruitment, retention or development as it relates to the addiction specialty providers in whatever setting they may work.
Please take a moment to provide us with a list of the three to five organizations that you would consider the best in these practices in your state.
Organization name _____________________________________
Organization Address ________________________________________________________
Contact info if you have it _____________________________________________________
Organization name _____________________________________
Organization Address ________________________________________________________
Contact info if you have it _____________________________________________________
Organization name _____________________________________
Organization Address ________________________________________________________
Contact info if you have it _____________________________________________________
Organization name _____________________________________
Organization Address ________________________________________________________
Contact info if you have it _____________________________________________________
Organization name _____________________________________
Organization Address ________________________________________________________
Contact info if you have it _____________________________________________________
Thank-you for your time!
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | johnsonk |
| File Modified | 0000-00-00 |
| File Created | 2021-01-25 |