Search:
Agenda
Reg Review
ICR
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0930-0300
ICR Reference No:
201207-0930-002
Status:
Historical Inactive
Previous ICR Reference No:
200903-0930-003
Agency/Subagency:
HHS/SAMHSA
Agency Tracking No:
Title:
Enhancing Substance Abuse Treatment Services to Address Hepatitis Infection Among Intravenous Drug Users Hepatitis Testing and Vaccine Tracking Form
Type of Information Collection:
Reinstatement without change of a previously approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Withdrawn
Conclusion Date:
10/31/2012
Retrieve Notice of Action (NOA)
Date Received in OIRA:
07/09/2012
Terms of Clearance:
If SAMHSA chooses to re-submit this package, the agency shall revise the supporting statements to focus on service delivery and not program evaluation. This collection is not a program evaluation and only tracks a service delivery process.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
36 Months From Approved
Responses
0
50,000
0
Time Burden (Hours)
0
2,500
0
Cost Burden (Dollars)
0
0
0
Abstract:
The information collected on the Form will solicit and reflect the following information: 1)Demographics (age, gender, ethnicity) of designated OTP site 2)History (Screening) of Hepatitis C exposure 3)Results of Rapid Hepatitis C Testing (Kit) and Follow-up information 4)Service Provided (type of vaccine given) Divalent vaccine (Twinrix- combination HAV and HBV) or Monovalent vaccine ( HAV or/and HBV) 5)Substance Abuse Treatment Outcomes (Information regarding the beginning, continuing or completion of vaccination series) 6)Type of Referral Services Indicated (ie; Gastroenterology, TB; Mental Health, Counseling, Reproductive/Prenatal, etc.)
Authorizing Statute(s):
US Code: 42 USC 501 Name of Law: SAMHSA
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
77 FR 24211
04/23/2012
30-day Notice:
Federal Register Citation:
Citation Date:
77 FR 37912
06/25/2012
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
SAMHSA/CSAT's Viral Hepatitis Information Form
Hepatitis Reporting Form
Hepatitis Reporting Form
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
There is no burden change from the previous approval.
Annual Cost to Federal Government:
$93,000
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [PPACA, P.L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Act [Dodd-Frank Wall Street Reform and Consumer Protection Act, P.L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Agency Contact:
Summer King 2402761243
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
07/09/2012
About Us
Related Resources
Disclosure
Accessibility
Privacy Policy
Contact Us
