Knowledge Application Program (KAP)

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⚠️ Notice: This information collection may be referencing outdated material.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 Product Feedback S Knowledge Application Program (KAP) Form and Instruction
Customer Informati Customer Information Survey Revised Attachment 1 - KAP PFS 8-23-17 092117cb.docx Form and Instruction
Product Feedback S Product Feedback Survey Revised Attachment 2 - KAP CIS 8-23-17 092117cb.docx Form and Instruction
Trans.Let-3-2017.doc Transmittal Letter IC Document
KAP KAP OMB SS 8-29-17.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Knowledge Application Program (KAP)	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
Form and Instruction	Product Feedback Survey	Product Feedback Survey	Revised Attachment 2 - KAP CIS 8-23-17 092117cb.docx		Yes	Yes	Fillable Fileable
Form and Instruction	Customer Information Survey	Customer Information Survey	Revised Attachment 1 - KAP PFS 8-23-17 092117cb.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	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	1,000	1,000
Annual IC Time Burden (Hours)	108	108
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Transmittal Letter	Trans.Let-3-2017.doc	08/29/2017
Supporting Statement	KAP KAP OMB SS 8-29-17.docx	08/29/2017

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