NATIONAL ALCOHOL AND DRUG ADDICTION RECOVERY MONTH CUSTOMER SATISFACTION FORM

We would like to know about your National Alcohol and Drug Addiction Recovery Month (Recovery Month) efforts this September and how useful you found this toolkit as you planned your activities. This information will be used in the development of future outreach materials distributed by the Center for Substance Abuse Treatment, a division of the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services.

Your response is voluntary, but your input is essential so that the Recovery Month materials we provide in future years will continue to meet your needs. Please complete this form and return it by mail or fax to the address below by October 31, 2004. We encourage you to include photographs and/or samples of supporting materials from your Recovery Month activities.

NOTE: Public reporting for this collection of information is estimated to average 10 minutes per response. 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, Paperwork Reduction Project (0930-0197); Room 16-105, Parklawn Building, 5600 Fishers Lane, Rockville, MD 20857. 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 0930-0197.