Uniform Application for the Community MH Services BG and SAPT BG Application Guidance and Instructions FY 2012-2013

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form MH Reporting Secti Application	Form and Instruction	Modified	Available
Attachment C - Summary of Block Grant Public Comments 6-17-11 final.docx	Supplementary Document	Uploaded 2011-06-17	Available
Attachment B - Public Comments.docx	Supplementary Document	Uploaded 2011-06-17	Available
BG Supporting Statement Final 6.17.11.doc	Supporting Statement A	Uploaded 2011-06-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7545	Application	Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0168	ICR Reference No: 201106-0930-001
Status: Historical Active	Previous ICR Reference No: 200805-0930-001
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Uniform Application for the Community MH Services BG and SAPT BG Application Guidance and Instructions FY 2012-2013
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: 07/19/2011
	Date Received in OIRA: 06/17/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2014	36 Months From Approved	08/31/2011
Responses	119	0	59
Time Burden (Hours)	37,429	0	15,710
Cost Burden (Dollars)	0	0	0

---

Abstract: SAMHSA's SAPTBG and MHSBG are designed to provide States with the flexibility to design and implement activities and services to address the complex needs of individuals, families, and communities impacted by mental disorders, substance use disorders and associated problems. The goals of the Block Grant programs are consistent with SAMHSA's vision for a high-quality, self-directed, and satisfying life in the community for everyone in America.

---

Authorizing Statute(s): US Code: 42 USC 1917 Name of Law: Application for Grant - MH
   US Code: 42 USC 1932 Name of Law: Application for Grant - SAPT
  

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:
	76 FR 19999	04/11/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 35454	06/17/2011
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Application	MH Reporting Section, SA_Reporting _Section, BG_Planning_Section	MH Reporting Section ,   SA_Reporting _Section ,   BG_Planning_Section

---

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	119	59	0	60	0	0
Annual Time Burden (Hours)	37,429	15,710	0	21,719	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: Currently the MHSBG has 15,710 and the SAPTBG has 33,325 burden hours in the OMB Inventory; a total of 49,035. SAMHSA is now requesting 37,429 total burden hours. The decrease of 11,606 hours is due to a program change.

---

Annual Cost to Federal Government: $1,913,111

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 06/17/2011

---