Client Survey

Targeted Capacity Expansion Program for Substance Abuse Treatment and HIV/AIDS Services (TCE-HIV)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0317 can be found here:

Documents and Forms

Document Name Document Type
Form Attachments 1a and Client Survey Form and Instruction
Attachments 1a and Attachments 1a and 1b - Instruments Attachments 1a and 1b.pdf Form and Instruction
Attachments 2a, 2b, 2c, and 2d.pdf Attachments 2a, 2b, 2c, and 2d - Others IC Document

Information Collection (IC) Details

IC Title:	Client Survey	Agency IC Tracking Number:

Is this a Common Form? No		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	Attachments 1a and 1b - Instruments	Attachments 1a and 1b - Instruments	Attachments 1a and 1b.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,600	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,480	4,480
Annual IC Time Burden (Hours)	1,882	1,882
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachments 2a, 2b, 2c, and 2d - Others	Attachments 2a, 2b, 2c, and 2d.pdf	08/02/2010

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