View Information Collection Request (ICR) Package
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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:
0930-0286
ICR Reference No:
201512-0930-006
Status:
Historical Active
Previous ICR Reference No:
201308-0930-001
Agency/Subagency:
HHS/SAMHSA
Agency Tracking No:
20339
Title:
Cross-Site Evaluation of the Garrett Lee Smith Memorial Suicide Prevention and Early Intervention Program
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
03/15/2016
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/28/2015
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
03/31/2019
36 Months From Approved
01/31/2017
Responses
12,902
0
20,347
Time Burden (Hours)
4,129
0
8,014
Cost Burden (Dollars)
0
0
0
Abstract:
The information collected through the four stages of the cross-site evaluation of the GLS Suicide Prevention and Early Intervention Programs will describe for State/Tribal grantees (1) the context in which suicide prevention activities are being implemented, (2) the products and services funded through the program, (3) the training experiences of individuals who receive training as part of the suicide prevention programs, (4) the utilization and penetration of the skills, knowledge and techniques learned through suicide prevention training programs, and (5) the referral networks in place to support youth identified at risk for suicide.
Authorizing Statute(s):
US Code:
42 USC 520E-2
Name of Law: Mental and Bhavioral Health Services on Campus
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:
80 FR 60694
10/07/2015
30-day Notice:
Federal Register Citation:
Citation Date:
80 FR 80376
12/24/2015
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
5
IC Title
Form No.
Form Name
Adolescents - State/Tribal - Trainees
D7.Training Utilization and Preservation Survey , D8. TUP-S-A Consent-to-Contact
D7.Training Utilization and Preservation Survey (TUP-S-A)- Adolescent Version.docx
,
D8. TUP-S-A Consent-to-Contact and Youth Assent Forms.docx
Behavioral Health Providers/Stakeholders - State/Tribal
RNS StateTribal, BHPS StateTribal
BHPS StateTribal
,
RNS StateTribal
Project Evaluators - Campus
SBHF Data Abstraction Campus, PSI Campus , TASP Campus
PSI Campus
,
TASP Campus
,
SBHF Data Abstraction Campus
Project Evaluators - State/Tribal
PSI StateTribal , TASP StateTribal , EIRF-Screening Form StateTribal, EIRF-Individual Form StateTribal
PSI StateTribal
,
TASP StateTribal
,
EIRF-Individual Form StateTribal
,
EIRF-Screening Form StateTribal
Providers - Campus - Trainees
Campus--Provider (Trainees) Instruments
Campus--Provider (Trainees) Instruments
Providers Trainees - State/Tribal
Provider Trainee Instruments
Provider Trainee Instruments
Student - Campus
SMSS Campus, TUP-S Campus
TUP-S Campus
,
SMSS Campus
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
12,902
20,347
0
-7,445
0
0
Annual Time Burden (Hours)
4,129
8,014
0
-3,885
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:
Currently there are 8,014 annual burden hours in the OMB inventory. SAMHSA is requesting 4,129 annual burden hours for this submission, representing a program change of a decrease of 3,885 annual burden hours. More Details are described in supporting statement - A - section 15.
Annual Cost to Federal Government:
$4,339,803
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:
12/28/2015
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