Minority Substance Abuse/HIV Prevention Initiative

ICR 201208-0930-001

OMB: 0930-0298

Federal Form Document

Forms and Documents
Document
Name
Status
Form
New
Form
Modified
Supplementary Document
2012-09-24
Supporting Statement B
2013-01-24
Supplementary Document
2012-07-16
Supplementary Document
2012-07-16
Supplementary Document
2012-07-16
Supporting Statement A
2013-01-24
IC Document Collections
IC ID
Document
Title
Status
203550 New
187120 Modified
ICR Details
0930-0298 201208-0930-001
Historical Active 200811-0930-002
HHS/SAMHSA
Minority Substance Abuse/HIV Prevention Initiative
Reinstatement with change of a previously approved collection   No
Regular
Approved with change 02/10/2013
Retrieve Notice of Action (NOA) 08/01/2012
As shown by the changes made to this collection, SAMHSA shall correctly enter its burden information in ROCIS. In addition, SAMHSA shall continue to address issues associated with respondent selection, response verification, and incentive use.
  Inventory as of this Action Requested Previously Approved
02/29/2016 36 Months From Approved
20,512 0 0
15,049 0 0
0 0 0

The Youth and Adult Minority Substance Abuse Questionnaires will be used to survey populations at risk for Substance Abuse, HIV/AIDS, and hepatitis. The participants are those in the Program who receive direct services for over 30 days at three time points: (1) baseline (program entry), (2) program exit, and (3) three to six months post-exit.

US Code: 42 USC 516 Name of Law: Priority Substance Abuse Prevention Needs of Reginional and National Significance
  
None

Not associated with rulemaking

  77 FR 29355 05/17/2012
77 FR 41794 07/16/2012
No

2
IC Title Form No. Form Name
Adult Adult Questionnaire Adult Questionnaire
Youth Youth Questionnaire Youth Questionnaire

  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 20,512 0 0 20,512 0 0
Annual Time Burden (Hours) 15,049 0 0 15,049 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is reinstatement.

$710,806
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Summer King 2402761243

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/01/2012


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