Multiplier Surveys

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Web-based Survey Web-based Survey	Form and Instruction	New	Available
Form Project Director S Project Director Survey	Form and Instruction	New	Available
Multiplier_Supporting_Statement_Final.doc	Supporting Statement B	Uploaded 2010-11-29	Available
Attachment C.docx	Supplementary Document	Uploaded 2010-08-17	Available
Multiplier_Supporting_Statement_Final.doc	Supporting Statement A	Uploaded 2010-11-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
194421	Web-based Survey	Form and Instruction	New
194420	Project Director Survey	Form and Instruction	New

ICR Details

OMB Control No: 0930-0318	ICR Reference No: 201008-0930-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Multiplier Surveys
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: 11/30/2010
	Date Received in OIRA: 08/26/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2013	09/30/2011
Responses	148	0	0
Time Burden (Hours)	135	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Each SAMHSA grantee reports performance data to SAMHSA as part of their grant; however, little is known about the impact of programs and the extent to which they are sustained after Federal funding ends. The Multiplier Surveys propose to address this lack of information by identifying program factors, grantee characteristics and contextual factors that support sustainability and effective grant implementation by conducting one-time interviews with project directors and surveying grantees from twelve programs selected from the three SAMHSA Centers.

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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 16812	04/02/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 50766	08/17/2010
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
Project Director Survey	Project Director Survey, Project Director Survey	Project Director Survey ,   Project Director Survey
Web-based Survey	Web-based Survey, Web-based Survey	Web-based Survey ,   Web-based Survey

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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	148	0	0	148	0	0
Annual Time Burden (Hours)	135	0	0	135	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: $188,455

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: 08/26/2010

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