Information Collection

Dtac

IC 238175 under ICR 201610-0930-005 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DTAC Feedback Surv DTAC	Form and Instruction
DTAC Feedback Surv DTAC Feedback Survey SAMHSA DTAC CFS _OMB Attachment A-10.3.19.docx	Form and Instruction
SAMHSA DTAC CFS OMB Justification 10.3.19 (2).docx Justification	IC Document
Trans.Let-4-2019.doc Memo	IC Document

IC Title:

DTAC

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DTAC Feedback Survey	DTAC Feedback Survey	SAMHSA DTAC CFS _OMB Attachment A-10.3.19.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification	SAMHSA DTAC CFS OMB Justification 10.3.19 (2).docx	10/17/2019
Memo	Trans.Let-4-2019.doc	10/17/2019

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