View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	SAMHSA 988 Media Campaign Evaluation Omnibus 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	Campaign Eval Survey Items	Campaign Eval Survey Items	SAMHSA 988 Campaign Eval Survey items_Adults and Teens_Wave 3_v1.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Privacy Act of 1975 (Title 5 United States Code [U.S.C.] 552a)	FR Citation: 75 FR 28264

Number of Respondents: 1	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 New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1	0	1	0	0	0
Annual IC Time Burden (Hours)	1	0	1	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Survey Consent	Omnibus Survey Consent Process.docx	07/08/2025
Request Template	SAMHSA Research 988 Eval OMB package.docx	07/08/2025

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