View Information Collection Request (ICR) Package

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: 0930-0383	ICR Reference No: 201812-0930-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Technology Transfer Center (TTC) Program Monitoring
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/08/2019
	Date Received in OIRA: 12/21/2018
Terms of Clearance: Clearance is provided consistent with the understanding that if SAMHSA seeks to extend this form, it will include an analysis of the feasibility of generating unique identifiers that do not include any digits of Social Security Numbers or similar National Identification Numbers.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2022	36 Months From Approved
Responses	128,250	0	0
Time Burden (Hours)	19,988	0	0
Cost Burden (Dollars)	0	0	0

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Event Description Form	Event Description Form
Follow-up Forms	Follow-up Form - International, Follow-up Form - Domestic	,
Post Event Forms	Post Event Form - International, Post Event Form - Domestic	,

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	128,250	128,250
Annual Time Burden (Hours)	19,988	19,988
Annual Cost Burden (Dollars)	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: No

Burden Reduction Due to:

Short Statement: This is a new data collection.

Annual Cost to Federal Government: $78,234

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. 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

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