Evaluation of Pregnant and Postpartum Women (PPW)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Instrument for Pro Program Director	Form and Instruction	New	Repair queued
Form Instrument for Cou Counselor	Form and Instruction	New	Repair queued
Form Instrument for Cli Clinical Director/Supervisor	Form and Instruction	New	Repair queued
Form Instrument for Pro Project Director	Form and Instruction	New	Repair queued
Form Instruments for Pr Project Staff	Form and Instruction	New	Repair queued
Form Instruments for Me Medical Staff	Form and Instruction	New	Repair queued
Form Instrument for Chi Children	Form and Instruction	New	Repair queued
Form Instrument for Par Partners/Fathers	Form and Instruction	New	Repair queued
Form Instruments for Mo Mothers	Form and Instruction	New	Repair queued
PPW OMB supporting statement 9-1-2010.doc	Supporting Statement B	Uploaded 2010-10-06	Repair queued
Attachment K - FRN comment.pdf	Supplementary Document	Uploaded 2010-10-06	Repair queued
Attachment J - PPW Materials.pdf	Supplementary Document	Uploaded 2010-10-06	Repair queued
Attachment B-2 - Supporting Document for Children.pdf	Supplementary Document	Uploaded 2010-10-06	Repair queued
Attachment C-2 - Supporting Documents for Partners-Fathers.pdf	Supplementary Document	Uploaded 2010-10-06	Repair queued
Attachment A-2 - Supporting Documents for Mothers.pdf	Supplementary Document	Uploaded 2010-10-06	Repair queued
PPW OMB supporting statement 9-1-2010.doc	Supporting Statement A	Uploaded 2010-10-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
195016	Program Director	Form and Instruction	New
195015	Counselor	Form and Instruction	New
195014	Clinical Director/Supervisor	Form and Instruction	New
195013	Project Director	Form and Instruction	New
195012	Project Staff	Form and Instruction	New
195011	Medical Staff	Form and Instruction	New
195010	Children	Form and Instruction	New
195009	Partners/Fathers	Form and Instruction	New
195008	Mothers	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 201010-0930-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Evaluation of Pregnant and Postpartum Women (PPW)
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 01/26/2011
	Date Received in OIRA: 10/26/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The primary purpose of the PPW Program is to provide cost-effective, comprehensive residential substance abuse treatment services for women and their minor children that can be sustained over time. To measure the achievement of this goal, CSAT is conducting this Evaluation and program monitoring to measure the outcomes of treatment at each project on maternal and child outcomes, including maternal substance abuse, quality of life, infant birth outcomes, and early childhood development.

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Authorizing Statute(s): US Code: 5 USC 508 Name of Law: Residential Treatment Programs for Pregnant and Postpartum Women
  

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 37447	06/29/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 61144	10/04/2010
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 9

table that charts list of burden

IC Title	Form No.	Form Name
Project Director	Instrument for Project Director	Instrument for Project Director
Clinical Director/Supervisor	Instrument for Clinical Director	Instrument for Clinical Director
Counselor	Instrument for Counselor	Instrument for Counselor
Program Director	Instrument for Program Director	Instrument for Program Director
Mothers	Instruments for Mothers	Instruments for Mothers
Partners/Fathers	Instrument for Partners-Fathers	Instrument for Partners-Fathers
Children	Instrument for Children	Instrument for Children
Medical Staff	Instruments for Medical Staff	Instruments for Medical Staff
Project Staff	Instruments for Project Staff	Instruments for Project Staff

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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: $1,968,462

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? Yes

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: 10/26/2010

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