Cross-Community Evaluation of the Native Aspirations Project

Forms and Documents

Document Name	Status
Form Agency_Instruments Agency Staff Form and Instruction	New
Form Community_Readines Community Readiness Form and Instruction	New
Form Community_Youth_In Community Member - Youth Form and Instruction	New
Form Community_Adult_In Community Member - Adult Form and Instruction	New
Form Service_Provider_I Service Providers Form and Instruction	New
Form Informant_Communit Community Plan Form and Instruction	New
Form GONA_Youth_Instrum GONA - Youth Form and Instruction	New
Form GONA_Adult_Instrum GONA - Adult Form and Instruction	New
Evaluation_of_the_Native_Aspirations_Project_10_01_10-2 Supporting Statement A & B.doc Supporting Statement B	2010-10-04
Attachment 14-Community_Readiness_Supporting.pdf Supplementary Document	2010-06-10
Attachment 12-Community_Youth_Supporting.pdf Supplementary Document	2010-06-10
Attachment 10-Community_Adult_Supporting.pdf Supplementary Document	2010-06-10
Attachment 8-Service_Provider_Supporting.pdf Supplementary Document	2010-06-10
Attachment 6-Key_Informant_Community_Supporting.pdf Supplementary Document	2010-06-10
Attachment 4-Key_Informant_GONA_Youth_Supporting.pdf Supplementary Document	2010-06-10
Attachment 2-Key_Informant_GONA_Adult_Supporting.pdf Supplementary Document	2010-06-10
Evaluation_of_the_Native_Aspirations_Project_10_01_10-2 Supporting Statement A & B.doc Supporting Statement A	2010-10-04

IC Document Collections

IC ID	Document Title	Status
193430	Agency Staff Form and Instruction	New
193429	Community Readiness Form and Instruction	New
193428	Community Member - Youth Form and Instruction	New
193427	Community Member - Adult Form and Instruction	New
193426	Service Providers Form and Instruction	New
193425	Community Plan Form and Instruction	New
193424	GONA - Youth Form and Instruction	New
193423	GONA - Adult Form and Instruction	New

ICR Details

OMB Control No: 0930-0315	ICR Reference No: 201006-0930-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Cross-Community Evaluation of the Native Aspirations Project
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: 10/08/2010
	Date Received in OIRA: 06/28/2010
Terms of Clearance: The agency will not make conclusions about the impact or outcome of the Native Aspirations Project using this collection. The agency will provide OIRA with a copy of the final report.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2013	36 Months From Approved
Responses	5,844	0	0
Time Burden (Hours)	6,977	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The program provides community-specific technical assistance on topics such as high-risk youth, evidence-based interventions, community readiness assessments, resource management, community planning, and preparation for community mobilization.

---

Authorizing Statute(s): US Code: 5 USC 505 Name of Law: Data Collection
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 31958	07/06/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 32947	06/10/2010
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 8

IC Title	Form No.	Form Name
GONA - Adult	GONA_Adult_Instruments	GONA_Adult_Instruments
GONA - Youth	GONA_Youth_Instruments	GONA_Youth_Instruments
Community Plan	Informant_Community_Instruments	Informant_Community_Instruments
Service Providers	Service_Provider_Instruments	Service_Provider_Instruments
Community Member - Adult	Community_Adult_Instruments	Community_Adult_Instruments
Community Member - Youth	Community_Youth_Instruments, Community_Youth_Instruments	Community_Youth_Instruments ,   Attachment 11-Youth Instrument Revised 9-30-10
Community Readiness	Community_Readiness_Instruments	Community_Readiness_Instruments
Agency Staff	Agency_Instruments	Agency_Instruments

---

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	5,844	0	0	5,844	0	0
Annual Time Burden (Hours)	6,977	0	0	6,977	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.

---

Annual Cost to Federal Government: $759,975

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]? No

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

---

Common Form ICR:  No

---

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: 06/28/2010

---