ADOLESCENT ASSESSMENT/REFERRAL SYSTEM

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
112026	ADOLESCENT ASSESSMENT/REFERRAL SYSTEM	Migrated

ICR Details

OMB Control No: 0930-0152	ICR Reference No: 199103-0930-006
Status: Historical Active	Previous ICR Reference No: 199301-0925-013
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: ADOLESCENT ASSESSMENT/REFERRAL SYSTEM
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 without change	Conclusion Date: 06/24/1991
	Date Received in OIRA: 03/29/1991
Terms of Clearance: Approved for use through 9/92 under the following conditions: o ADAMHA deletes question 27 in Part 1 of the Personal Experience Inventory. o No later than 7/31/91 ADAMHA submits to OMB a report describing how interrater reliability will be maintained for the Pre-implementation Tracking Form, in particular for Part IV. Problems. o ADAMHA revises the AARS Case Refusal Form to include additional detail on the reasons the non respondent adolescent was referred to the agency. Additional detail on each of the reasons for referral may be needed to comprehensively describe and fully understand the non response bias and population. o The payment for the validation study will not exceed $10.00.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/1992	09/30/1992
Responses	2,102	0	0
Time Burden (Hours)	2,953	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: AN ANALYSIS IS PLANNED OF THE ADOLESCENT ASSESSMENT/REFERRAL SYSTEM (AARS), A TREATMENT PLANNING SYSTEM FOR SUBSTANCE ABUSERS AGED 12-19. THE STUDY WILL GATHER DATA TO REFINE AND VALIDATE THE AARS AND ASSESS RESOURCES AND TECHNICAL ASSISTANCE NEEDED TO SUPPORT IMPLEMENTATION. RESPONDENTS WILL BE 606 ADOLESCENTS AND 18 AGENCIES VOLUNTARILY ADOPTING THE AARS.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
ADOLESCENT ASSESSMENT/REFERRAL SYSTEM

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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	2,102	0	0	2,102	0	0
Annual Time Burden (Hours)	2,953	0	0	2,953	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:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 03/29/1991

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