The Healthy Transitions Initiative Cross-Site Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form State Administrato State Administrators	Form and Instruction	New	Repair queued
Form Local Administrato Local Administrators	Form and Instruction	New	Repair queued
Form Transition Program Transitional Program Personnel	Form and Instruction	New	Repair queued
Form Youth Mentor Instr Youth Mentors	Form and Instruction	New	Repair queued
Form Young Person Instr Young Persons	Form and Instruction	New	Repair queued
HTI OMB SS_B_8.6.12.docx	Supporting Statement B	Uploaded 2012-08-06	Repair queued
Transition Program Assessment Protocol Excerpt from Anchored Scale_Attachment B.pdf	Supplementary Document	Uploaded 2012-08-06	Repair queued
Consent Forms_Attachments M,N.pdf	Supplementary Document	Uploaded 2012-08-06	Repair queued
Healthy Transitions Grant Application RFA_Attachment A.pdf	Supplementary Document	Uploaded 2012-08-06	Repair queued
Other.pdf	Supplementary Document	Uploaded 2012-08-06	Repair queued
HTI OMB SS_A_8.6.12.docx	Supporting Statement A	Uploaded 2012-08-06	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
203613	State Administrators	Form and Instruction	New
203612	Local Administrators	Form and Instruction	New
203611	Transitional Program Personnel	Form and Instruction	New
203610	Youth Mentors	Form and Instruction	New
203609	Young Persons	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 201208-0930-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: The Healthy Transitions Initiative Cross-Site Evaluation
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 10/26/2012
	Date Received in OIRA: 08/06/2012
Terms of Clearance: SAMHSA has requested this collection be withdrawn as a result of funding changes.

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 cross-site evaluation of the Cooperative Agreements for State/Community Partnerships to Integrate Services and Supports for Youth and Young Adults 16-25 with Serious Mental Health Conditions and Their Families, also known as the Healthy Transitions Initiative, or HTI. The purpose of the HTI is to create developmentally appropriate and effective youth-guided local systems of care to improve outcomes for youth and young adults with serious mental health conditions in areas such as education, employment, housing, and behavioral and other health and co-occurring disorders, and to decrease contacts with the juvenile and criminal justice systems.

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Authorizing Statute(s): US Code: 42 USC 290bb-32 Name of Law: Priority Mental Health Needs of Regional and National Significance
  

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 26773	05/07/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 40370	07/09/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Young Persons	Young Person Instruments	Young Person Instruments
Youth Mentors	Youth Mentor Instrument	Youth Mentor Instrument
Transitional Program Personnel	Transition Program Personnel Instruments	Transition Program Personnel Instruments
Local Administrators	Local Administrator Instrument	Local Administrator Instrument
State Administrators	State Administrator Instrument	State Administrator Instrument

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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: $547,643

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: 08/06/2012

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