Participant Feedback Forms for the Mental Health Care Provider Education (MHCPE) in the HIV/AIDS Program

Forms and Documents

Document Name	Status
Form Forms and Instruct Participant Feedback Forms for the Mental Health Care Provider Education (MHCPE) in the HIV/AIDS Program Form and Instruction	Modified
0195-07-SS_10-25-07.doc Supporting Statement B	2007-10-25
Forms-Instructions.zip Supporting Statement A	2007-10-25

IC Document Collections

IC ID	Document Title	Status
7583	Participant Feedback Forms for the Mental Health Care Provider Education (MHCPE) in the HIV/AIDS Program Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0195	ICR Reference No: 200711-0930-003
Status: Historical Active	Previous ICR Reference No: 200408-0930-002
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Participant Feedback Forms for the Mental Health Care Provider Education (MHCPE) in the HIV/AIDS Program
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/02/2008
	Date Received in OIRA: 11/16/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2011	36 Months From Approved	12/31/2007
Responses	12,600	0	12,600
Time Burden (Hours)	1,843	0	1,843
Cost Burden (Dollars)	0	0	0

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Abstract: These standardized forms will collect systematic feedback from trainees participating in the Minority HIV/AIDS Mental Health Treatment and Education Services Program and the Mental Health Care Provider Education in HIV/AIDS III Program. The overall goal of the two programs is to help create a cadre of traditional and non-traditional mental health service providers who utilize state-of-the-art information on the psychological and neuropsychological sequelae of HIV/AIDS, and to enhance the nation's ability to have an impact on the HIV/AIDS epidemic.

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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:
	72 FR 31842	06/08/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 61361	10/30/2007
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
Participant Feedback Forms for the Mental Health Care Provider Education (MHCPE) in the HIV/AIDS Program	Forms and Instructions	Forms and Instructions

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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	12,600	12,600	0	0	0	0
Annual Time Burden (Hours)	1,843	1,843	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $395,000

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: 11/16/2007

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