National Cross-Site Assessment of Addiction Technology Transfer Centers (ATTC) Network

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Event Description Event Description Form	Form and Instruction	Modified	Available
Form Follow-up Form Follow-up Form	Form and Instruction	Modified	Available
Form 2.6 CSAT Customer CSAT Customer Sat Survey Training Follow-up	Form and Instruction	Removed	Available
Form 2.5 CSAT Customer CSAT Customer Sat Survey Training	Form and Instruction	Removed	Available
Form 2.3 CSAT Customer CSAT Customer Sat Survey TA	Form and Instruction	Removed	Available
Form 2.2 CSAT Customer CSAT Customer Sat Survey Meeting Follow-up	Form and Instruction	Removed	Available
Form 2.1 CSAT Customer CSAT Customer Sat Survey Meeting	Form and Instruction	Removed	Available
Form 1.5 ATTC Follow-up ATTC Follow-up Event Cust Sat Survey Training	Form and Instruction	Removed	Available
Form 1.4 ATTC Post Even ATTC Post Event Cust Sat Survey Training	Form and Instruction	Removed	Available
Form 1.3 ATTC Pre-Event ATTC Pre-Event Form Training	Form and Instruction	Removed	Available
Form 1.2 ATTC Pre-Event ATTC Pre-Event Form Meetings & TA	Form and Instruction	Removed	Available
Form 1.1 ATTC Event Des ATTC Event Description Form	Form and Instruction	Removed	Available
Form 2.4 CSAT Customer CSAT Customer Sat Survey TA Follow-up	Form and Instruction	Removed	Repair queued
Form Post Event Forms Post Event Forms	Form and Instruction	Modified	Available
Form GPRA GPRA	Form and Instruction	Modified	Repair queued
Form Post Event Forms Post Event Forms	Form and Instruction	Modified	Repair queued
Attachment.11.Statement.of.Informed.Consent(2).doc	Supplementary Document	Uploaded 2010-04-19	Available
Attachment.10.Contact.Information.Form(2).doc	Supplementary Document	Uploaded 2010-04-19	Repair queued
Attachment.9.Model.Statement.doc	Supplementary Document	Uploaded 2010-04-13	Available
Attachment.8.Cover.page.for.instruments(2).doc	Supplementary Document	Uploaded 2010-04-19	Available
Attachment.7.Sample.Cover.Letters(2).doc	Supplementary Document	Uploaded 2010-04-19	Available
Attachment.6.ATTC.Regional.Centers.doc	Supplementary Document	Uploaded 2010-04-13	Available
Attachment.5.Summary.of.Revisions.doc	Supplementary Document	Uploaded 2010-04-13	Available
OMBSupporting Statement 4-7-10.doc	Supporting Statement B	Uploaded 2010-04-08	Available
Other.zip	Supplementary Document	Uploaded 2010-01-27	Available
Terms-06-Report.doc	Supplementary Document	Uploaded 2006-12-28	Available
Terms-06-Memo.doc	Supplementary Document	Uploaded 2006-12-28	Available
Attachment 8 Statement of Informed Consent for Followup.doc	Supplementary Document	Uploaded 2006-12-28	Available
Attachment 7 Contact Information Form.doc	Supplementary Document	Uploaded 2006-12-28	Available
Attachment 6 Model Statement.doc	Supplementary Document	Uploaded 2006-12-28	Available
Attachment 5 Cover page for instruments.doc	Supplementary Document	Uploaded 2006-12-28	Available
Attachment 4 Sample Cover Letters.doc	Supplementary Document	Uploaded 2006-12-28	Available
Attachment 3 ATTC Network Regional Centers.doc	Supplementary Document	Uploaded 2006-12-28	Available
Other.zip	Supplementary Document	Uploaded 2010-01-27	Available
Other.zip	Supplementary Document	Uploaded 2010-01-27	Available
Other.zip	Supplementary Document	Uploaded 2010-01-27	Available
OMBSupporting Statement 4-7-10.doc	Supporting Statement A	Uploaded 2010-04-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7618	ATTC - Event Description Form	Form and Instruction	Modified	Event Description Form
46705	ATTC - Training Follow-up	Form and Instruction	Modified	Follow-up Form
46704	ATTC	Form and Instruction	Removed	CSAT Customer Sat Survey Training Follow-up
46704	ATTC	Form and Instruction	Removed	CSAT Customer Sat Survey Training
46704	ATTC	Form and Instruction	Removed	CSAT Customer Sat Survey TA
46704	ATTC	Form and Instruction	Removed	CSAT Customer Sat Survey Meeting Follow-up
46704	ATTC	Form and Instruction	Removed	CSAT Customer Sat Survey Meeting
46704	ATTC	Form and Instruction	Removed	ATTC Follow-up Event Cust Sat Survey Training
46704	ATTC	Form and Instruction	Removed	ATTC Post Event Cust Sat Survey Training
46704	ATTC	Form and Instruction	Removed	ATTC Pre-Event Form Training
46704	ATTC	Form and Instruction	Removed	ATTC Pre-Event Form Meetings & TA
46704	ATTC	Form and Instruction	Removed	ATTC Event Description Form
46704	ATTC	Form and Instruction	Removed	CSAT Customer Sat Survey TA Follow-up
46703	ATTC - Training - Post Event	Form and Instruction	Modified	Post Event Forms
46701	ATTC - TA - Post Event	Form and Instruction	Modified	GPRA
46701	ATTC - TA - Post Event	Form and Instruction	Modified	Post Event Forms

ICR Details

OMB Control No: 0930-0216	ICR Reference No: 201002-0930-001
Status: Historical Active	Previous ICR Reference No: 200701-0930-003
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: National Cross-Site Assessment of Addiction Technology Transfer Centers (ATTC) Network
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/30/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/22/2010
Terms of Clearance: Approved consistent with the understanding that, at the time of renewal, SAMHSA will provide OMB with a description of the level of success achieved in the use of the 25% sampling strategy and whether the Program was able to obtain the anticipated 80% response rate.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2013	36 Months From Approved	04/30/2010
Responses	42,750	0	63,950
Time Burden (Hours)	6,663	0	9,200
Cost Burden (Dollars)	0	0	0

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Abstract: The ATTC Network is a nationwide, multi-disciplinary resource that draws upon the knowledge, experience, and latest research of recognized experts in the field of addictions. The network is comprised of 14 ATTCs representing all States, the District of Columbia, Puerto Rico, the Virgin Islands and the Pacific Islands and a National Office to coordinate cross-site activities. Training activities, meetings and technical assistance are provided to treatment professionals through the network. The National Cross-Site Assessment will obtain pre-event, followup, and post event information from all participants.

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Authorizing Statute(s): US Code: 5 USC 509 Name of Law: Priority Substance Abuse Treatment Needs of Regional and National Significance
  

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:
	74 FR 51283	10/06/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 4397	01/27/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
ATTC	1.4 ATTC Post Event Cust Sat Survey Training, 2.4 CSAT Customer Sat Survey TA Follow-up, 1.5 ATTC Follow-up Event Cust Sat Survey Training, 2.1 CSAT Customer Sat Survey Meeting, 2.2 CSAT Customer Sat Survey Meeting Follow-up, 2.3 CSAT Customer Sat Survey TA, 2.5 CSAT Customer Sat Survey Training, 2.6 CSAT Customer Sat Survey Training Follow-up, 1.1 ATTC Event Description Form, 1.2 ATTC Pre-Event Form Meetings & TA, 1.3 ATTC Pre-Event Form Training	ATTC Event Description Form ,   ATTC Pre-Event Form Meetings & TA ,   ATTC Pre-Event Form Training ,   ATTC Post Event Cust Sat Survey Training ,   CSAT Customer Sat Survey TA Follow-up ,   ATTC Follow-up Event Cust Sat Survey Training ,   CSAT Customer Sat Survey Meeting ,   CSAT Customer Sat Survey Meeting Follow-up ,   CSAT Customer Sat Survey TA ,   CSAT Customer Sat Survey Training ,   CSAT Customer Sat Survey Training Follow-up
ATTC - TA - Post Event	Post Event Forms, GPRA	Post Event Forms ,   GPRA
ATTC - Event Description Form	Event Description Form	Event Description Form
ATTC - Training - Post Event	Post Event Forms	Post Event Forms
ATTC - Training Follow-up	Follow-up Form	Follow-up Form

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ICR Summary of Burden

table that charts list 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	42,750	63,950	0	-21,200	0	0
Annual Time Burden (Hours)	6,663	9,200	0	-2,537	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Currently, there are 9,200 burden hours in the OMB inventory. The Program is requesting 6,662.50 hours, a decrease of 2,537.50 hours. This decrease is due to the elimination of the Pre Event forms for all event types.

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Annual Cost to Federal Government: $7,610,000

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)? No

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: 02/22/2010

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