View Information Collection Request (ICR) Package
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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:
0930-0270
ICR Reference No:
201203-0930-002
Status:
Historical Active
Previous ICR Reference No:
200809-0930-002
Agency/Subagency:
HHS/SAMHSA
Agency Tracking No:
Title:
Toolkit Protocol for the Crisis Counseling Assistance and Training Program (CCP)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
08/17/2012
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/20/2012
Terms of Clearance:
As shown by the changes made to this collection, SAMHSA shall continue verify its burden estimates are accurate and consistent throughout the submission. SAMHSA shall insert the correct OMB control number (0930-0270) on all instruments.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2015
36 Months From Approved
08/31/2012
Responses
53,000
0
128,400
Time Burden (Hours)
7,622
0
12,297
Cost Burden (Dollars)
0
0
0
Abstract:
Data collection about services delivered and users of the services will be collected from the CCPs through standardized information tools which will then be reported to SAMHSA for appropriate processing and analysis. CCPs will be required to use the tools for data collection throughout the life of the program.
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:
76 FR 71351
11/17/2011
30-day Notice:
Federal Register Citation:
Citation Date:
77 FR 9679
02/17/2012
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
6
IC Title
Form No.
Form Name
Asessment and Referral Tool
N/A, N/A
Adult Assessment and Referral tool
,
Child Youth Assessment and Referral Tool
Group Encounter Log
N/A
Group Encounter Log
Individual/Family Crisis Counseling Servies Encounter Log
N/A
Individual Family Encounter Form
Particpant Feedback Form
N/A
Participant Feedback Form
Service Provider Feedback Form
N/A
Service Provider Feedback Form
Weekly Tally Sheet
N/A
Weekly Tally Sheet
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
53,000
128,400
0
-75,400
0
0
Annual Time Burden (Hours)
7,622
12,297
0
-4,675
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
The current burden estimate is 12,297 hours. SAMHSA CMHS is requesting a decrease in burden to 7,662 total burden hours. This adjustment is mainly due to the updated utilization rates of the Individual/Family Encounter Log, Group Encounter Log, and Assessment and Referral Tools, in addition to the reduction of forms needed to be completed due to the combined Individual/Family Encounter Log (see Item 12 of this supporting statement). Additional time is required to complete the two additional fields in the Weekly Tally Sheet.
Annual Cost to Federal Government:
$59,619
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 [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
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:
03/19/2012
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