Field Test for the 2012 National Survey on Drug Use and Health (NSDUH)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Attachment B-CAI Interview	Form and Instruction	New	Available
2014-2017 NSDUH PrivacyActclearance.doc	Supplementary Document	Uploaded 2012-08-21	Available
OMB SS-B qft 5-13-12.docx	Supporting Statement B	Uploaded 2012-05-17	Available
Attachment Q.pdf	Supplementary Document	Uploaded 2012-05-17	Available
Attachment O,P-Letters.pdf	Supplementary Document	Uploaded 2012-05-17	Available
Attachments L,M,N.pdf	Supplementary Document	Uploaded 2012-05-17	Available
Attachment K.pdf	Supplementary Document	Uploaded 2012-05-17	Available
Attachment I,J.pdf	Supplementary Document	Uploaded 2012-05-17	Available
Attachment H.pdf	Supplementary Document	Uploaded 2012-05-17	Available
Attachments F,G,R,S.pdf	Supplementary Document	Uploaded 2012-05-17	Available
Attachments A,C,D,E.pdf	Supplementary Document	Uploaded 2012-05-17	Available
OMB SS-A qft 5-13-12.docx	Supporting Statement A	Uploaded 2012-05-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202479	Interview Verification	Instruction	New
202478	Screening Verification	Instruction	New
202477	Interview	Form and Instruction	New
202476	Household Screening	Instruction	New

ICR Details

OMB Control No: 0930-0334	ICR Reference No: 201205-0930-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Field Test for the 2012 National Survey on Drug Use and Health (NSDUH)
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: 08/26/2012
	Date Received in OIRA: 05/25/2012
Terms of Clearance: As shown by the changes to the collection, SAMHSA shall upload and explain the coverage of all related privacy documentation.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2015	12 Months From Approved
Responses	5,738	0	0
Time Burden (Hours)	2,804	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: SAMHSA's Center for Behavioral Health Statistics and Quality (CBHSQ) must update the NSDUH periodically to reflect changing substance abuse and mental health issues. CBHSQ is planning to redesign the NSDUH for the 2015 survey year. The redesign will seek to achieve two main goals: 1) to revise the questionnaire to address changing policy and research data needs, and 2) to modify the survey methodology to improve the quality of estimates and the efficiency of data collection and processing. SAMHSA is requesting approval to conduct a Questionnaire Field Test (QFT) to test revisions to the questionnaire associated with these goals.

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Authorizing Statute(s): US Code: 42 USC 505 Name of Law: Data Collection
  

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:
	77 FR 12319	02/29/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 26560	05/04/2012
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Household Screening
Interview	Attachment B-CAI	Attachment B-CAI
Screening Verification
Interview Verification

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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	5,738	0	0	5,738	0	0
Annual Time Burden (Hours)	2,804	0	0	2,804	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: $524,160

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: 05/25/2012

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