Parents' Night Out During Presentation Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 Parents' Nigtht Ou Parents' Night Out During Presentation Survey Form and Instruction
Parents' Nigtht Ou Parents' Nigtht Out During Presentation Survey Parents_Night_Out_During_Pres_Survey(Att-A).docx Form and Instruction
PNO_Supplemental_Statement-Justification_Attachment A.docx PNO_Supplemental_Statement-Justification_Attachment A IC Document

Information Collection (IC) Details

IC Title:	Parents' Night Out During Presentation Survey	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	Parents' Nigtht Out During Presentation Survey	Parents' Nigtht Out During Presentation Survey	Parents_Night_Out_During_Pres_Survey(Att-A).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Parents' Nigtht Out During Presentation Survey	FR Citation: 75 FR 28264

Number of Respondents: 500	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	500	500
Annual IC Time Burden (Hours)	70	70
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PNO_Supplemental_Statement-Justification_Attachment A	PNO_Supplemental_Statement-Justification_Attachment A.docx	02/22/2021

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