OMB No. 0930-0393
Expiration Date: 03/31/2026
Web survey: SAMHSA Store v2
Navigation (1=Poor, 10=Excellent, Don’t Know)
Please rate how well the site is organized.
Please rate the options available for navigating this site.
Please rate how well the site layout helps you find what you are looking for.
Site Performance (1=Poor, 10=Excellent, Don’t Know)
Please rate how quickly pages load on this site.
Please rate the consistency of speed from page to page on this site.
Please rate the ability to load pages without getting an error message on this site.
Site Information (1=Poor, 10=Excellent, Don’t Know)
Please rate the thoroughness of information provided on this site. Please rate how understandable this site’s information is. Please rate how well the site’s information provides answers to your questions.
Look and Feel (1=Poor, 10=Excellent, Don’t Know))
Please rate the visual appeal of this site
Please rate the balance of graphics and text on this site
Please rate the readability of the pages on this site.
Information Browsing (1=Poor, 10=Excellent, Don’t Know)
Please rate the ability to sort information by criteria that is important to you on this site.
Please rate the ability to narrow choices to find the information you are looking for on this site.
Please rate how well the features on the site help you find the information you are looking for.
Satisfaction
What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)
How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)
How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)
Future Behaviors
How likely are you to return to this site? (1=Very Unlikely, 10=Very Likely)
How likely are you to recommend this site to someone else? (1=Very Unlikely, 10=Very Likely)
How likely are you to use this site as your primary resource for obtaining and ordering publications from this agency? (1=Very Unlikely, 10=Very Likely)
Custom Questions
How frequently do you visit the SAMHSA Store?
First time
Daily
Weekly
Monthly
Once every few months or less often
What is your primary interest in substance abuse and mental health topics?
Personal
For whom are you looking up information and resources
Yourself
Family member
Friend
What is the age of the person for whom you are seeking resources?
12 and under
13 to 17
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 and older
Are you primarily looking for information on any of the following topics?
Treatment and recovery
Please specify the topic of interest for treatment and recovery. (Check all that apply)
Understanding different types of treatment
Information about specific substances of abuse
Information about specific mental illnesses
Preventing substance abuse problems
Please specify the topic of interest for substance abuse prevention. (Check all that apply)
Alcohol
Marijuana
Prescription drugs
Tobacco
Other substances (e.g., cocaine, heroin)
Preventing mental illness/promoting mental wellness
Please specify the topic of interest for preventing mental illness and promoting mental wellness. (Check all that apply)
Anger management
Anxiety or depression
Bullying prevention
Eating disorders
PTSD
Schizophrenia
Stress management
Suicide prevention
Helping someone cope with and recover from a traumatic event
Please specify the topic of interest for trauma recovery. (Check all that apply)
Death of a loved one
Physical or sexual abuse
Natural disaster
Mass violence
Post-military deployment
Other, please specify
Please specify other information looking for.
Professional
What best describes your organization type?
Behavioral health treatment facility
Criminal justice/courts
Health insurer
Human resources/employee assistance programs
Individual or group private practice
Managed care/insurance company office
Military/veterans’ group
Nonprofit/community-based organization/coalition
Non-residential/out-patient facility
Public place/interacting in community
Residential/in-patient facility
School/university
Other
Please specify your organization
For whom are you primarily looking for information and resources
Professional education for self/colleagues
Use with patients/clients
Use within classroom/youth setting
Public awareness campaign/event
Other
Which of the following best describes the age of your patients, clients or students?
12 and under
13-17
18-24
25-34
35-44
45-54
55-64
65 and older
Were you primarily looking for information on any of the following topics?
Treatment and recovery
Please specify the topic of interest for treatment and recovery . (Check all that apply)
Patient/client educational materials
Evidence based practices
Information for working with specific population
Information about specific substances of abuse
Information about specific mental illness
Substance abuse prevention
Please specify the topic of interest for substance abuse prevention. (Check all that apply)
Alcohol
Marijuana
Prescription drugs
Tobacco
Other substances (e.g. cocaine, heroin)
Parenting/family resources
Preventing mental illness/promoting mental wellness
Please specify the topic of interest for preventing mental illness and promoting mental wellness . (Check all that apply)
Anger management
Bullying prevention
Eating disorders
Mood disorders
PTSD
Schizophrenia
Stress management
Suicide prevention
Parenting/family resources
Trauma
Please specify the topic of interest for trauma . (Check all that apply)
Grief
Physical or sexual abuse
Natural disaster
Mass violence
Post-military deployment
Other, please specify
Please specify other information looking for
Did you find what you were looking for?
Yes
No
Partially
Still looking
How satisfied were you with the content available?
Very satisfied
Somewhat satisfied
No opinion
Somewhat dissatisfied
Please tell us how our products and resources could be improved
Very dissatisfied
Please tell us how our products and resources could be improved
What services could this agency provide to better serve you?
Please specify the types of electronic devices you use. (Check all that apply)
Desktop or laptop computer
Tablet or e-reader (e.g., iPad, Kindle, Nook)
Smartphone (e.g., iPhone or similar devices with web access)
Cell phone
What is your gender
Female
Male
Prefer not to respond
Please select the category that includes your age
17 and under
18-24
25-34
35-44
45-54
55-64
65 and older
Prefer not to respond
Which of the following best describes the highest level of education you have completed?
Current middle or high school student
Did not complete high school
High school graduate
Some college/vocational school
College graduate
Some postgraduate school
Graduate/professional degree
MD/PhD
Prefer not to respond
Where do you live?
United States
Please select your state.
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Prefer not to respond
U.S. Territories or Possessions
Please select your place of residence.
American Samoa
Guam
Northern Mariana Islands
Puerto Rico
U.S. Virgin Islands
International (please specify)
Please specify your country.
Are you living in a:
Urban area
Rural area
Don't know
How do you describe your ethnicity?
Hispanic
Non-Hispanic
Prefer not to respond
How do you describe your race?
American Indian or Alaska native
Asian or pacific islander
African American or black
White
Other
Prefer not to respond
If you have a visual impairment, was the content accessible?
Yes
No
Please share your difficulties regarding your experience.
I do not have a visual impairment
Were you able to access the content in the language of your choice?
Yes
No (
Please specify the language you would prefer.
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0393, and it expires 03/31/2026. Public reporting burden for this collection of information is estimated to average 23 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E57A, Rockville, MD 20857.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Goldberg, Darren |
File Modified | 0000-00-00 |
File Created | 2023-08-30 |