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Federal forms, ICRs, and supporting documents

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Evaluating the Applicability and Use of The Commmunity Guide among SAMHSA Grantees

IC 225311 under ICR 201606-0920-007 · OMB 0920-0974.

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Evaluating the Applicability and Use of The Commmunity Guide among SAMHSA Grantees 17NQ
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none SAMHSA Grantees Survey SAMHSA Grantees survey 1-23-2017.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

255 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 255 0 255 0 0 0
Annual IC Time Burden (Hours) 64 0 64 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Email Invitation Provide Feedback on The Community Guide invitation email script (SAMHSA) 1-13-17.docx 01/25/2017
Follow-up Email Provide Feedback on The Community Guide follow-up email script (SAMHSA) 1-13-17.docx 01/25/2017
Survey page 1a Screenshot of Survey page 1a.PNG 01/25/2017
Survey page 1b Screenshot of SAMHSA Survey page 1b.PNG 01/25/2017
Survey page 2 Screenshot of SAMHSA Survey page 2.PNG 01/25/2017
Survey page 3 Screenshot of SAMHSA Survey page 3.PNG 01/25/2017
Survey page 4 Screenshot of SAMHSA Survey page 4.PNG 01/25/2017
Survey page 5 Screenshot of SAMHSA Survey page 5.PNG 01/25/2017
Survey page 6 Screenshot of SAMHSA Survey page 6.PNG 01/25/2017
Survey page 7 Screenshot of SAMHSA Survey page 7.PNG 01/25/2017
Survey page 8 Screenshot of SAMHSA Survey page 8.PNG 01/25/2017
Survey page 9 Screenshot of SAMHSA Survey page 9.PNG 01/25/2017
Survey page 10 Screenshot of SAMHSA Survey page 10.PNG 01/25/2017
Survey page 11 Screenshot of SAMHSA Survey page 11.PNG 01/25/2017
Survey page 12 Screenshot of SAMHSA Survey page 12.PNG 01/25/2017
Survey page 13 Screenshot of SAMHSA Survey page 13.PNG 01/25/2017
Request for Approval Fast_Track_GenIC_Request CGB Customer feedback SAMHSA grantees 1-26-17.docx 01/31/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.