The Safe Schools/Healthy Students (SS/HS) National Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Staff Climate Surv The Safe Schools/Healthy Students (SS/HS) National Evaluation	Form and Instruction	New	Repair queued
OMB Supporting Statement 01-12-07a.doc	Supporting Statement B	Uploaded 0000-00-00	Repair queued
OMB Supporting Statement 01-12-07a.doc	Supporting Statement A	Uploaded 0000-00-00	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
178968	The Safe Schools/Healthy Students (SS/HS) National Evaluation	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 200703-0930-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: The Safe Schools/Healthy Students (SS/HS) National Evaluation
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 07/20/2007
	Date Received in OIRA: 03/08/2007
Terms of Clearance: Withdrawn per SAMHSA request.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The information to be collected annually via the Staff School Climate Survey is an integral part of the congressionally mandated national cross-site evaluation of the SS/HS Initiative. Instituted by Congress following the murderous assaults at Columbine High School in Colorado, the SS/HS Initiative is designed to provide LEAs, including school districts and multidistrict regional consortia, with 3 years of funding to simultaneously improve: school safety, student access to mental health services, reduction of violence and substance abuse, school relationships with the larger community, early childhood, and preparation for learning.

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Authorizing Statute(s): US Code: 5 USC 501 Name of Law: SAMHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 45570	08/09/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 9767	03/05/2007
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
The Safe Schools/Healthy Students (SS/HS) National Evaluation	Staff Climate Survey	Staff Climate Survey

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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.

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Annual Cost to Federal Government: $106

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]? 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: 03/08/2007

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