Program Evaluation for Assertive Adolescent & Family Treatment (AAFT) Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Data Manager Surve Evaluator/Data Manager	Form and Instruction	New	Available
Form Clinical Superviso Clinical Supervisor/Clinician	Form and Instruction	New	Available
Form Director Survey Director	Form and Instruction	New	Available
Data Collection Plan.doc	Supplementary Document	Uploaded 2011-05-04	Available
OMB Supporting Statement National AAFT Evaluation_revised_FINAL DRAFT.doc	Supporting Statement B	Uploaded 2011-05-12	Available
B3. All staff emails.doc	Supplementary Document	Uploaded 2011-01-04	Available
B2. All other staff emails.doc	Supplementary Document	Uploaded 2011-01-04	Available
B1. PI.PD emails.doc	Supplementary Document	Uploaded 2011-01-04	Available
OMB Supporting Statement National AAFT Evaluation_revised_FINAL DRAFT.doc	Supporting Statement A	Uploaded 2011-05-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
196214	Evaluator/Data Manager	Form and Instruction	New
196213	Clinical Supervisor/Clinician	Form and Instruction	New
196212	Director	Form and Instruction	New

ICR Details

OMB Control No: 0930-0323	ICR Reference No: 201102-0930-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Program Evaluation for Assertive Adolescent & Family Treatment (AAFT) Program
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: 05/12/2011
	Date Received in OIRA: 02/15/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2014	36 Months From Approved
Responses	105	0	0
Time Burden (Hours)	79	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The AAFT Implementation Survey will be used as the primary method for measuring the readiness of AAFT3 grantees to implement the project as well as collect data implementation process throughout the life of the grant. More specifically, the survey will contain questions about the background, experience, and skills of service providers and administrators at each site, as well as practices and behaviors that may or may not change over time as a result of the training and technical assistance offered through this grant.

---

Authorizing Statute(s): US Code: 42 USC 290bb-7 Name of Law: Substance Abuse Treatment Services for Children and Adolescents
  

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:
	75 FR 45124	08/02/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 1446	01/10/2011
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Director	Director Survey , Director Survey	Director Survey
Clinical Supervisor/Clinician	Clinical Supervisors Survey	Clinical Supervisors Survey
Evaluator/Data Manager	Data Manager Survey	Data Manager Survey

---

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	105	0	0	105	0	0
Annual Time Burden (Hours)	79	0	0	79	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: $60,761

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: 02/15/2011

---