Dtac

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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

IC Title:	DTAC	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	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 %

	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

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.