Targeted Capacity Expansion Grants for Jail Diversion Programs

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Baseline Interview Baseline Interview	Form and Instruction	Modified	Available
Form Arrest Data Collec Arrest Data Collection Form	Form and Instruction	Modified	Available
Form Service Use Data C Service Use Data Collection Form	Form and Instruction	Modified	Available
Form Tracking Informati Tracking Information Form	Form and Instruction	Modified	Available
Form Event Tracking Scr Event Tracking Screen	Form and Instruction	Modified	Available
Form Twelve Month Inter Twelve Month Interview	Form and Instruction	Modified	Available
Form Six Month Intervie Six Month Interview	Form and Instruction	Modified	Available
H Example of an Informed Consent Form 12.27.12.pdf	Supplementary Document	Uploaded 2012-12-31	Available
OMBJustification_B_JDTR_12.27.12.docx	Supporting Statement B	Uploaded 2012-12-31	Available
H Example of an Informed Consent Form 12.27.12.pdf	Supplementary Document	Uploaded 2012-12-31	Available
I Follow-up Interview Reminder Letter.doc	Supplementary Document	Uploaded 2012-08-24	Available
OMBJustification_ A_JDTR_12.27.12.docx	Supporting Statement A	Uploaded 2012-12-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7692	Targeted Capacity Expansion Grants for Jail Diversion Programs - Baseline	Form and Instruction	Modified	Baseline Interview
190662	Targeted Capacity Expansion Grants for Jail Diversion Programs - Submission	Instruction	Modified
190661	Targeted Capacity Expansion Grants for Jail Diversion Programs - Arrest History	Form and Instruction	Modified	Arrest Data Collection Form
190660	Targeted Capacity Expansion Grants for Jail Diversion Programs - Service Use	Form and Instruction	Modified	Service Use Data Collection Form
190659	Targeted Capacity Expansion Grants for Jail Diversion Programs - Person Tracking	Form and Instruction	Modified	Tracking Information Form
190658	Targeted Capacity Expansion Grants for Jail Diversion Programs - Events Tracking	Form and Instruction	Modified	Event Tracking Screen
190657	Targeted Capacity Expansion Grants for Jail Diversion Programs - 12 Months	Form and Instruction	Modified	Twelve Month Interview
190656	Targeted Capacity Expansion Grants for Jail Diversion Programs- 6 Months	Form and Instruction	Modified	Six Month Interview

ICR Details

OMB Control No: 0930-0277	ICR Reference No: 201209-0930-002
Status: Historical Active	Previous ICR Reference No: 201005-0930-002
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Targeted Capacity Expansion Grants for Jail Diversion Programs
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: 01/08/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/07/2012
Terms of Clearance: As shown to the changes made to the collection, SAMHSA shall continue to include PRA statement and to explain clearly its incentives policy.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2016	36 Months From Approved	01/31/2013
Responses	7,511	0	15,201
Time Burden (Hours)	1,145	0	3,014
Cost Burden (Dollars)	0	0	0

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Abstract: The Jail Diversion Programs divert individuals with mental illness and often co-occurring disordes in contact with the justice system from jail and provide linkages to community- based traetment and support servies. The individual thus avoids or spends a significantly reduce time in jail and/or lockups on the current charge or on violations of probation resulting from previous charges.

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Authorizing Statute(s): US Code: 42 USC 520 Name of Law: CMHS
  

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 37426	06/21/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 51035	08/23/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Targeted Capacity Expansion Grants for Jail Diversion Programs - 12 Months	Twelve Month Interview	Twelve Month Interview
Targeted Capacity Expansion Grants for Jail Diversion Programs - Arrest History	Arrest Data Collection Form	Arrest Data Collection Form
Targeted Capacity Expansion Grants for Jail Diversion Programs - Baseline	Baseline Interview	Baseline Interview
Targeted Capacity Expansion Grants for Jail Diversion Programs - Events Tracking	Event Tracking Screen	Event Tracking Screen
Targeted Capacity Expansion Grants for Jail Diversion Programs - Person Tracking	Tracking Information Form	Tracking Information Form
Targeted Capacity Expansion Grants for Jail Diversion Programs - Service Use	Service Use Data Collection Form	Service Use Data Collection Form
Targeted Capacity Expansion Grants for Jail Diversion Programs - Submission
Targeted Capacity Expansion Grants for Jail Diversion Programs- 6 Months	Six Month Interview	Six Month Interview

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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	7,511	15,201	0	0	-7,690	0
Annual Time Burden (Hours)	1,145	3,014	0	0	-1,869	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $429,217

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: 09/07/2012

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