Augmentation Screener

National Survey of Substance Abuse Treatment Services (N-SSATS)

Documents and Forms

Document Name Document Type
Form Augmentation Scree Augmentation Screener Form and Instruction
Augmentation Scree Augmentation Screener Questionnaire Attachment A3_as of 2020-02-26_Augmentation Screener Questionnaire.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Augmentation Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Augmentation Screener Questionnaire	Augmentation Screener Questionnaire	Attachment A3_as of 2020-02-26_Augmentation Screener Questionnaire.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,300	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,300	1,300
Annual IC Time Burden (Hours)	104	104
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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