Information Collection

2020 021 Foresee_Q_SAMHSAStore_Web_Browse updated April 8 2020

IC 241361 under ICR 201805-1090-003 · OMB 1090-0008.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 020 2020 021 Foresee_Q_SAMHSAStore_Web_Browse updated April 8 2020	Form and Instruction
020 2020 021 Foresee_Q_SAMHSAStore_Web_Browse updated April 2020 021 Foresee_Q_SAMHSAStore_Web_Browse updated April 8 2020.xlsx	Form and Instruction
1090-0008 Generic Clearance Request Form SAMHSA Store April 2020 signed.pdf 1090-0008 Generic Clearance Request Form SAMHSA Store April 2020 signed	IC Document
1090-0008 Survey Mapping Document SAMHSA Store April 2020.docx 1090-0008 Survey Mapping Document SAMHSA Store April 2020	IC Document

IC Title:

2020 021 Foresee_Q_SAMHSAStore_Web_Browse updated April 8 2020

Agency IC Tracking Number:

020

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	020	2020 021 Foresee_Q_SAMHSAStore_Web_Browse updated April 8 2020	2020 021 Foresee_Q_SAMHSAStore_Web_Browse updated April 8 2020.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: 0 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
1090-0008 Generic Clearance Request Form SAMHSA Store April 2020 signed	1090-0008 Generic Clearance Request Form SAMHSA Store April 2020 signed.pdf	04/16/2020
1090-0008 Survey Mapping Document SAMHSA Store April 2020	1090-0008 Survey Mapping Document SAMHSA Store April 2020.docx	04/16/2020

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