Targeted Capacity Expansion Program for Substance Abuse Treatment and HIV/AIDS Services (TCE-HIV)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Partner-Collaborat Partner-Collaborator Instruments	Form and Instruction	Modified	Available
Form Direct Service Sta Direct Service Staff Instruments	Form and Instruction	Modified	Available
Form Administrative Sta Administrative Staff Instruments	Form and Instruction	Modified	Available
Form Client Instruments Client Instruments	Form and Instruction	Modified	Available
Form Client Instruments Client Instruments	Form and Instruction	Modified	Available
Form Client Instruments Client Instruments	Form and Instruction	Modified	Available
Form Client Instruments Client Instruments	Form and Instruction	Modified	Available
TCE-HIV OMB Supporting Statement 10-19-10 FINAL.docx	Supporting Statement B	Uploaded 2010-10-22	Available
Attachment 2C-Client Other-cont'd-2.pdf	Supplementary Document	Uploaded 2010-10-20	Available
Attachment 2B-Client Other-cont'd.pdf	Supplementary Document	Uploaded 2010-10-20	Available
Attachment 2A-Client Other.pdf	Supplementary Document	Uploaded 2010-10-20	Available
Attachment 8-Partner-Collaborator Other.pdf	Supplementary Document	Uploaded 2010-10-20	Available
Attachment 6-Direct Services Other.pdf	Supplementary Document	Uploaded 2010-10-20	Available
Attachment 4-Administrative Staff Other.pdf	Supplementary Document	Uploaded 2010-10-20	Available
Attachment 2C-Client Other-cont'd-2.pdf	Supplementary Document	Uploaded 2010-10-20	Available
Attachment 2B-Client Other-cont'd.pdf	Supplementary Document	Uploaded 2010-10-20	Available
Attachment 2A-Client Other.pdf	Supplementary Document	Uploaded 2010-10-20	Available
TCE-HIV OMB Supporting Statement 10-19-10 FINAL.docx	Supporting Statement A	Uploaded 2010-10-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
194046	Collaborators/Partners	Form and Instruction	Modified	Partner-Collaborator Instruments
194045	Direct Services Dosage	Instruction	Modified
194044	Direct Service Staff	Form and Instruction	Modified	Direct Service Staff Instruments
194043	Administrator	Form and Instruction	Modified	Administrative Staff Instruments
194042	Client FG	Form and Instruction	Modified	Client Instruments
194042	Client FG	Form and Instruction	Modified	Client Instruments
194041	Client	Form and Instruction	Modified	Client Instruments
194041	Client	Form and Instruction	Modified	Client Instruments

ICR Details

OMB Control No: 0930-0317	ICR Reference No: 201010-0930-001
Status: Historical Active	Previous ICR Reference No: 201008-0930-001
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Targeted Capacity Expansion Program for Substance Abuse Treatment and HIV/AIDS Services (TCE-HIV)
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: 11/19/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/24/2010
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
Responses	4,592	0	0
Time Burden (Hours)	2,076	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Multi-Site Evaluation is designed to monitor implementation activities of 48 SAMHSA TCE-HIV funded Grantees including the evidence based practices (EBPs), service delivery, and contextual factors that facilitate or impede program success. The Evaluation is also intended to obtain information on the risk behaviors, HIV testing/serostatus, social support, medical and mental health, and motivation for treatment from clients of the TCE-HIV Grantees and monitor their satisfaction with services received.

---

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

---

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 54830	06/23/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 35818	06/23/2010
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Administrator	Administrative Staff Instruments	Administrative Staff Instruments
Client	Client Instruments, Client Instruments	Client Instruments ,   Client Instruments
Client FG	Client Instruments, Client Instruments	Client Instruments ,   Client Instruments
Collaborators/Partners	Partner-Collaborator Instruments	Partner-Collaborator Instruments
Direct Service Staff	Direct Service Staff Instruments	Direct Service Staff Instruments
Direct Services Dosage

---

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	4,592	0	0	4,592	0	0
Annual Time Burden (Hours)	2,076	0	0	2,076	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: $2,130,178

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

---

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: 10/24/2010

---