Obligated Service for Mental Health Traineeships: Regulations and Forms

Forms and Documents

Document Name	Status
Form Form SMA 111-2 Obligated Service for Mental Health Traineeships: Regulations and Forms Form and Instruction	Modified
Payback OMB Support St .. 4-4-07.doc Supporting Statement A	0000-00-00

IC Document Collections

IC ID	Document Title	Status
7490	Obligated Service for Mental Health Traineeships: Regulations and Forms Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0074	ICR Reference No: 200704-0930-009
Status: Historical Active	Previous ICR Reference No: 200401-0930-004
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Obligated Service for Mental Health Traineeships: Regulations and Forms
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: 07/06/2007
	Date Received in OIRA: 04/19/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2010	36 Months From Approved	06/30/2007
Responses	57	0	79
Time Burden (Hours)	10	0	14
Cost Burden (Dollars)	0	0	0

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Abstract: Under authority of Sections 303 and 520 of the Public Health Service Act, SAMHSA's Center for Mental Health Services awards grants to institutions for traineeships in mental health and related disciplines. Recipients prior to September 30, 2000 of graduate level clinical traineeships in psychology, psychiatry, nursing, or social work (which is not of limited duration or experimental nature) must perform service, as determined by the Secretary to be appropriate in terms of the individual's training and experience, for a length of time equal to the period of support.

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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:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 5988	02/08/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 17568	04/09/2007
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
Obligated Service for Mental Health Traineeships: Regulations and Forms	Form SMA 111-2	Form SMA 111-2

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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	57	79	0	-22	0	0
Annual Time Burden (Hours)	10	14	0	-4	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Currently there is a total burden of 14 hours. The Program is requesting a total of 10 hours. The program change decrease of 4 hours due to the deletion of the requirement for service payback.

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Annual Cost to Federal Government: $75,000

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: 04/19/2007

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