The Safe School/Healthy Student (SS/HS) Initiative National Evalutation

Forms and Documents

Document Name	Status
Form Instruments SS/HS Form and Instruction	New
Revised Sampling Plan for SCS 103008 (3).doc Supporting Statement B	2009-01-08
Attachments1and9-13.zip Supplementary Document	2008-03-28
OMB Supporting Statement 08 14 07.doc Supporting Statement A	2008-03-28

IC Document Collections

IC ID	Document Title	Status
184514	SS/HS Form and Instruction	New

ICR Details

OMB Control No: 0930-0297	ICR Reference No: 200804-0930-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: The Safe School/Healthy Student (SS/HS) Initiative National Evalutation
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: 01/08/2009
	Date Received in OIRA: 04/17/2008
Terms of Clearance: Approved consistent with revisions to the sampling plan submitted by the Agency and included as an addendum.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2012	36 Months From Approved
Responses	106,675	0	0
Time Burden (Hours)	16,431	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The three Federal agencies collaborating on the Initiative share an expectation that LEAs and communities nationwide will benefit from the documented experiences of the grantees. A letter to introduce the National Evaluation Team (NET) was mailed to all grantees from the Director of the Division of Prevention, Traumatic Stress and Special Programs at SAMHSA. The NET has developed instruments to collect detailed quantitative and qualitative data on the grant activities and the local collaborative process. These instruments all apply to the local Project Director of the grant, the local project evaluator, one representative of each local organization that formally partners in the administration of the grant activities, one representative of each school receiving services through this grant, and instructional and administrative staff at targeted schools.

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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 55794	10/01/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 17367	04/01/2008
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
SS/HS	Instruments	Instruments

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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	106,675	0	0	106,675	0	0
Annual Time Burden (Hours)	16,431	0	0	16,431	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: 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: $3,220,000

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: 04/17/2008

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