SAMHSA DTAC 2023

1 

Service Provider Feedback Form Task Timeline

The following instructions provide information on the tasks to be completed before, during, and after administration of 

the Service Provider Feedback Form. The Substance Abuse and Mental Health Services Administration (SAMHSA)

Disaster Technical Assistance Center (DTAC) is providing this timeline to support you in successfully managing the 

survey process.

Attention: The SAMHSA Center for Mental Health Services (CMHS) and the Federal Emergency Management Agency 

(FEMA) strongly encourage all Crisis Counseling Assistance and Training Programs to administer the Service Provider 

Feedback Form using the online method. If, and only if, online administration is not possible, then paper administration of 

the survey is allowable. Please note below the specific instructions that only apply to administration of the paper survey. 

By When? By Whom? What? 

3 WEEKS

OR MORE 

BEFORE 

SURVEY

DTAC/State The state evaluation coordinator will collect the following:

• List of e-mail addresses—Create a list of e-mail addresses for crisis counselors 

(outreach workers) and team leaders.

SAMHSA DTAC will e-mail the following materials to the state evaluation 

coordinator, who will then modify them and send them to crisis counselors and 

team leaders. In the files that SAMHSA DTAC sends to you, the areas that you should 

change will be highlighted in yellow. The materials that will be sent are as follows:

• Boilerplate announcement—This announcement may be modified as desired. We

are sending it to help you let people know that a survey is coming. Circulate this 

information to your staff however works best in your setting (e.g., staff meeting,

flyer posting, e-mail).

• Boilerplate cover letter—Prepare the cover letter explaining why the survey is 

important, how the data will be used, how the crisis counselors’ (outreach workers’)

and team leaders’ identity is protected, and that participation is voluntary. The

project director may modify the cover letter as desired.

• Boilerplate thank you and reminder text—You won’t need this until 2 WEEKS 

AFTER THE SURVEY, but you can get it ready to go anytime.

2–3 

WEEKS 

BEFORE

State/Provider The state needs to contact SAMHSA DTAC staff with the following information: 

• Phone number to include on the survey—This phone number is for survey

participants to call anonymously if they are feeling highly stressed and need

assistance. SAMHSA DTAC will incorporate the number into the online survey. 

Please e-mail the number to your designated TA Specialist or to the SAMHSA

DTAC office at DTAC@samhsa.hhs.gov.

IF YOU PLAN TO DISTRIBUTE PAPER COPIES, please contact the person(s) at 

the state or provider organization who will be preparing the survey materials, and inform

him, her, or them of the following: 

• Precise number of survey participants—This is the number of crisis counselors 

(outreach workers) and team leaders to whom the survey will be given. Your contact 

person will need the actual number of people, not the number of all full-time

employees, because part-time employees are also eligible for the survey. This survey

is not for crisis counselors (outreach workers) or team leaders who have been

working in their position for less than a month and does not include people whose 

functions are solely administrative or clerical. The accuracy of this number is

important because it drives how many surveys will be prepared for you and

determines the response rate.
SAMHSA DTAC 2023

2 

By When? By Whom? What? 

1 WEEK 

BEFORE

State/Provider Prepare and distribute survey announcements. Send out e-mail text, or post paper

announcements to let the counselors (outreach workers) and team leaders know the

survey is coming.

WEEK OF 

SURVEY

State/Provider Finish customizing the e-mail cover letter that will be sent out with the link to the

online survey. 

IF DISTRIBUTING PAPER COPIES, then do the following: 

• Finish preparing the packets and distribute them to provider organizations. Each 9-

by 12-inch envelope will have the cover letter, a copy of the survey, and a pen. 

Instructions should be included to scan the survey and send it electronically to

dtac@iqsolutions.com.

1 WEEK 

AFTER

State Check with each provider organization individually to make sure it distributed the

surveys to its service providers.

2 WEEKS 

AFTER

State Send out the “thank you and reminder” e-mail or letter to crisis counselors (outreach 

workers) and team leaders. This communication will serve as a reminder to complete

and/or return the survey for those who have not yet done so. (DTAC will stop entering

data received in paper form 5 weeks after survey administration.) 

6–7 

WEEKS 

AFTER

SAMHSA

DTAC

Send the state and federal partners, SAMSHA CMHS and FEMA, a report of the 

survey results.