Assessment of the Underage Drinking Prevention: Town Hall Meetings Initiative

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Attachment 2 - Par Participants Survey	Form and Instruction	New	Available
Form Attachment 1 - Org Organizers Survey	Form and Instruction	Modified	Available
THM OMB Package-Revised_110510-FINAL.doc	Supporting Statement B	Uploaded 2010-11-08	Available
Attachment 6-Registration-Confirmation of Participation Email_060110.doc	Supplementary Document	Uploaded 2010-08-02	Available
Attachment 5-Reminder Email to Organizers-Survey_060110.doc	Supplementary Document	Uploaded 2010-08-02	Available
Attachment 4-Initial Email to Organizers-Survey_060110.doc	Supplementary Document	Uploaded 2010-08-02	Available
THM OMB Package-Revised_110510-FINAL.doc	Supporting Statement A	Uploaded 2010-11-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
194189	Participants Survey	Form and Instruction	New
182093	Organizers Survey	Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0288	ICR Reference No: 201008-0930-003
Status: Historical Active	Previous ICR Reference No: 200709-0930-004
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Assessment of the Underage Drinking Prevention: Town Hall Meetings Initiative
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: 11/12/2010
	Date Received in OIRA: 08/10/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2013	36 Months From Approved	01/31/2011
Responses	15,400	0	1,200
Time Burden (Hours)	2,696	0	200
Cost Burden (Dollars)	0	0	0

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Abstract: SAMHSA/CSAP intends to support annual Town Hall Meetings (THMs). The information collected will be used by SAMHSA/CSAP to help plan for those annual events and to provide technical assistance and training to organizations that sponsor the events. The information will provide a descriptive picture of the nation-wide initiative, and it will indicate how the THMs were received and some factors that may be associated with well-received events.

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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:
	75 FR 13545	03/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 45126	08/02/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Participants Survey	Attachment 2 - Participants Survey, Attachment 2- Participants Survey, Attachment 2	Attachment 2 - Participants Survey ,   Attachment 2-Participants Survey ,   Attachment 2-Participant Form 102810-Final
Organizers Survey	Attachment 1 - Organizers Survey, Attachment 3 - Feedback Form, Attachment 1, Attachment 1	Attachment 1 - Organizers Survey ,   Attachment 3 - Feedback Form ,   Attachment 1-Organizers Survey 092710 ,   Attachment 1- Organizer Survey 110310-Final

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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	15,400	1,200	0	14,200	0	0
Annual Time Burden (Hours)	2,696	200	0	2,496	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: The increase in hours is due to a program change. A form for program participants was added to the collection.

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Annual Cost to Federal Government: $37,190

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]? No

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: 08/10/2010

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