Mapping and Questionnaire Documents IA 30839 A0 (SAMHSA)

E-Government Website Customer Satisfaction Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0008 can be found here:

Documents and Forms

Document Name Document Type
Form Q_SAMHSAMain_Web_B Mapping and Questionnaire Documents IA 30839 A0 (SAMHSA) Form and Instruction
Q_SAMHSAMain_Web_B Q_SAMHSAMain_Web_Browse_201760518 Q_SAMHSAMain_Web_Browse_201760518.xlsx Form and Instruction
Q_SAMHSAStore_Web_ Q_SAMHSAStore_Web_Browse_20160518 Q_SAMHSAStore_Web_Browse_20160518.xlsx Form and Instruction
1090-0008 Survey Mapping Document (SAMHSA) IA 30839 A0_draft.xlsx 1090-0008 Survey Mapping Document (SAMHSA) IA 30839 A0_draft IC Document
SAMHSA OMB Form 11.13.2018 IA 30839 A0.pdf SAMHSA OMB Form 11.13.2018 IA 30839 A0 IC Document

Information Collection (IC) Details

IC Title:	Mapping and Questionnaire Documents IA 30839 A0 (SAMHSA)	Agency IC Tracking Number:	30839 A0 (SAMHSA)

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	Q_SAMHSAMain_Web_Browse_201760518	Q_SAMHSAMain_Web_Browse_201760518	Q_SAMHSAMain_Web_Browse_201760518.xlsx		Yes	Yes	Fillable Fileable
Form and Instruction	Q_SAMHSAStore_Web_Browse_20160518	Q_SAMHSAStore_Web_Browse_20160518	Q_SAMHSAStore_Web_Browse_20160518.xlsx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
1090-0008 Survey Mapping Document (SAMHSA) IA 30839 A0_draft	1090-0008 Survey Mapping Document (SAMHSA) IA 30839 A0_draft.xlsx	03/14/2019
SAMHSA OMB Form 11.13.2018 IA 30839 A0	SAMHSA OMB Form 11.13.2018 IA 30839 A0.pdf	03/14/2019

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