CSAT Products and Materials Survey 

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Form Approved 

OMB NO. 0930-0197 

Exp. Date 01/31/2014 

CENTER FOR SUBSTANCE ABUSE TREATMENT Public reporting burden for this collection of information is estimated 

to average 10 minutes per response to complete this questionnaire. 

Send comments regarding this burden estimate or any other aspect of 

this collection of information to the SAMHSA Reports Clearance 

Officer, Room 7-1045, 1 Choke Cherry Road, Rockville, MD 20850. 

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 control number for this project is 

0930-0197. 

Customer Survey—Information Materials Subscriber 

1. Have you read one or more issues of NAME OF CSAT PRODUCT? 

 Yes  No If NO, Skip to 

Question 9. 

2. Planned of NAME OF CSAT PRODUCT: Satisfaction with Use 

3a. Please indicate whether you plan to use 

NAME OF CSAT PRODUCT in the 

following ways: 

3b. If “Y”, please indicate your satisfaction with this use. 

If “N”, please skip to the next item in Question 3a. 

Please mark “Y” for “Yes” 

or “N” for “No.” Very

Satisfied 

Somewhat 

Satisfied 

Neither 

Satisfied 

nor 

Dissatisfied 

Somewhat 

Dissatisfied Very Dissatisfied Don’t Know 

To keep informed of substance abuse 

treatment issues 

Circulate or route it to others 

Clip articles for informational purposes 

Place it in a prominent location for staff 

Use as a handout for customers/clients 

Reproduce article(s) in a publication 

Reference NAME OF CSAT PRODUCT 

in a publication 

Other 

(specify)_______________________ 





Y 

N 





Y 

N 





Y 

N 





Y 

N 





Y 

N 





Y 

N 





Y 

N 





Y 

N 

    

    

    

    

    

    

    

    





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Content: Satisfaction and Recommendations 

4a. How satisfied are you with NAME OF CSAT 

PRODUCT content? Very 

Satisfied 

Somewhat 

Satisfied 

Neither 

Satisfied nor 

Dissatisfied 

Somewhat 

Dissatisfied 

Very 

Dissatisfied 

Don’t 

Know 

Is it credible? 

Educates professionals working outside the substance 

abuse treatment field about addictive disorders? 

Educates professionals working outside the substance 

abuse treatment field on the social and cost benefits of 

treatment? 

Provides new information on substance abuse treatment? 

Provides timely information on substance abuse 

treatment? 

Provides substance abuse treatment information relevant 

to your profession? 

Provides references to substance abuse treatment 

information? 

Covers only one general topic area in each 

issue/document? 

Other content characteristic(s) 

(specify)__________________ 







































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4b. How would you characterize your overall 

satisfaction with the content of NAME OF 

CSAT PRODUCT ? 

     

5. What changes(s) can CSAT make to NAME OF CSAT PRODUCT content to improve or enhance its use? 

6. Thinking of your professional interests and the interests of others in your organization, which of the 

following topics, as they relate to substance abuse treatment, would be of interest to you in the future? 

(Mark all that apply) 

 Other(specify)______ 

 Adult needs  Health and wellness __________________ 

 Aging and senior  Healthcare reform _______________ 

citizens  HIV/AIDS, TB, and  Reasons for using 

 Alcohol abuse and other infectious and abusing 

alcoholism diseases  Rural health 

 Domestic violence  Highway safety  Support groups 

 Race and ethnicity  Women’s health  Treatment referrals 

 Don’t know 

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Format: Satisfaction and Recommendations 

7a. How satisfied are you that NAME OF CSAT 

PRODUCT? Very 

Satisfied 

Somewhat 

Satisfied 

Neither 

Satisfied nor 

Dissatisfied 

Somewhat 

Dissatisfied 

Very 

Dissatisfied 

Don’t 

Know 

Uses language appropriate to professionals in your field?      

Uses language that is easily understood by 

customers/clients?      

Contains culturally relevant language to your 

organization?      

Is easy to read?      

Is aesthetically pleasing?      

Has an appealing color scheme?      

Is an appropriate length?      

Includes articles of an appropriate length?      

Uses a two-column layout for the articles?      

Is easily recognizable when you receive it in the mail?      

Other format characteristic(s) 

(specify)__________________      

7b. How would you characterize your overall 

satisfaction with the format of NAME OF 

CSAT PRODUCT? 

     

8.	 What change(s) can CSAT make to the following format elements of NAME OF CSAT PRODUCT to 

improve or enhance its use? 

Language: ___________________________________________________________________________________ 

Readability: ___________________________________________________________________________________ 

Layout: ___________________________________________________________________________________ 

Length: ___________________________________________________________________________________ 

Recognition: ___________________________________________________________________________________ 

Other: ___________________________________________________________________________________ 
 

 

 

 

 

 

 

 

 

Dissemination of NAME OF CSAT PRODUCT 

9. Who in your organization should receive products such as NAME OF CSAT PRODUCT ? (Mark all that 

apply)  Director or other administrator 

	 Counselor or social worker 

 Office manager 

	 Administrative assistant or receptionist 

 Don’t know 

 Other (specify)______________________ 

10. What is the best way to send NAME OF CSAT PRODUCT to get it recognized and used by your 

organization? 

(Please check only one)
 

	 Send in the mail 

	 Send as an e-mail attachment 

	 Send as text in an e-mail 

	 Send e-mail notification of Internet postings 

	 Send as a fax 

	 Other (specify) __________________________ 

11. Please rank in descending order with “1” being the highest and “3” being the lowest, up to three 

organizational types that best describe your organization. (Please rank a maximum of three) 

___Court/judicial branch ___Local government agency ___Community organization 

___Law enforcement ___State government agency (non-governmental) 

___Legislative branch ___Substance abuse treatment ___Federal government agency ___Military ___Family focus ___College or university ___Advocacy group ___Non-profit ___Professional or academic ___Health association ___Other 

(specify)____________ ___Children and/or teens focus (specify)______________ 

Thank you for completing our survey. 

Please return your survey in the enclosed envelope.