National Survey of Substance Abuse Treatment Services (N-SSATS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form TEDS TEDS	Form and Instruction	Removed	Available
Form TEDS TEDS	Form and Instruction	Removed	Available
Form N-SSATS 2014 abbre N-SSATS 2014 abbreviated questionnaire	Form and Instruction	Modified	Available
Form Augmentation scree Augmentation screener questionnaire	Form and Instruction	Modified	Available
Form N-SSATS 2013 CATI N-SSATS 2013 CATI Questionnaire	Form and Instruction	Modified	Available
Form N-SSATS 2013 full N-SSATS 2013 full questionnaire	Form and Instruction	Modified	Available
Form N-SSATS 2013 web s N-SSATS 2013 web screens for on-line questionnaire	Form and Instruction	Modified	Available
Form I-BHS Facility app I-BHS Facility application form	Form and Instruction	Modified	Available
Form I-BHS Online forms I-BHS Online forms	Form and Instruction	Modified	Available
Form TEDS TEDS	Form and Instruction	Removed	Available
N-SSATS OMB SS-B 1.9.13.docx	Supporting Statement B	Uploaded 2013-01-09	Available
Attachment B10 - between cycle N-SSATS advance letter.docx	Supplementary Document	Uploaded 2012-10-22	Available
DASIS OMB - Other.zip	Supplementary Document	Uploaded 2009-10-19	Available
Attachment C2 - Participant list - March 2011.doc	Supplementary Document	Uploaded 2012-10-22	Available
Attachment C1 - Expert panel - Nov 2011.docx	Supplementary Document	Uploaded 2012-10-22	Repair queued
Attachment B11 - Web pages for the 2013 N-SSATS information website.pdf	Supplementary Document	Uploaded 2012-10-22	Available
Attachment B9 - N-SSATS 2013 Completion thank you letter.docx	Supplementary Document	Uploaded 2012-10-22	Available
Attachment B8 - N-SSATS 2013 2nd mailing cover letter.docx	Supplementary Document	Uploaded 2012-10-22	Available
Attachment B6 - N-SSATS 2013 Cover letter on-line instructions FAQ sheet.docx	Supplementary Document	Uploaded 2012-10-22	Available
Attachment B5 - N-SSATS 2013 Advance Letter.docx	Supplementary Document	Uploaded 2012-10-22	Available
Attachment B7 - N-SSATS 2013 Thank you reminder letter.docx	Supplementary Document	Uploaded 2012-10-22	Available
DASIS OMB - Other.zip	Supplementary Document	Uploaded 2009-10-19	Available
DASIS OMB - Other.zip	Supplementary Document	Uploaded 2009-10-19	Available
N-SSATS OMB SS-A 1.9.13.docx	Supporting Statement A	Uploaded 2013-01-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7513	Drug and Alcohol Services Information System - TEDS Admission	Form and Instruction	Removed	TEDS
191117	Drug and Alcohol Services Information System - TEDS Discharge Crosswalks	Form and Instruction	Removed	TEDS
191116	N-SSATS BC	Form and Instruction	Modified	N-SSATS 2014 abbreviated questionnaire
191115	Augmentation Screener	Form and Instruction	Modified	Augmentation screener questionnaire
191114	N-SSATS	Form and Instruction	Modified	N-SSATS 2013 CATI Questionnaire
191114	N-SSATS	Form and Instruction	Modified	N-SSATS 2013 full questionnaire
191114	N-SSATS	Form and Instruction	Modified	N-SSATS 2013 web screens for on-line questionnaire
191113	I-BHS Application	Form and Instruction	Modified	I-BHS Facility application form
191112	I-BHS	Form and Instruction	Modified	I-BHS Online forms
191111	Drug and Alcohol Services Information System - TEDS Discharge	Form and Instruction	Removed	TEDS

ICR Details

OMB Control No: 0930-0106	ICR Reference No: 201210-0930-005
Status: Historical Active	Previous ICR Reference No: 200910-0930-001
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: National Survey of Substance Abuse Treatment Services (N-SSATS)
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: 01/15/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/25/2012
Terms of Clearance: As shown by the changes made to this collection, SAMHSA shall fully explain its approach to response rates and the purpose of the collection. SAMHSA shall make its OIRA worksheet consistent with Q15 of the supporting statement.

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	29,440	0	24,541
Time Burden (Hours)	11,535	0	15,706
Cost Burden (Dollars)	0	0	0

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Abstract: There has been a name change for this data collection; from "DASIS" to the "National Survey of Substance Abuse Treatment Services (N SSATS)." N-SSATS is the main survey component from the prior collection which provides both national and state-level data on the numbers and types of patients treated and the characteristics of facilities providing substance abuse treatment services.

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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 50142	08/20/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 64530	10/22/2012
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
Augmentation Screener	Augmentation screener questionnaire	Augmentation screener questionnaire
Drug and Alcohol Services Information System - TEDS Admission	TEDS	TEDS
Drug and Alcohol Services Information System - TEDS Discharge	TEDS	TEDS
Drug and Alcohol Services Information System - TEDS Discharge Crosswalks	TEDS	TEDS
I-BHS	I-BHS Online forms	I-BHS Online forms
I-BHS Application	I-BHS Facility application form	I-BHS Facility application form
N-SSATS	N-SSATS 2013 full questionnaire, N-SSATS 2013 web screens for on-line questionnaire, N-SSATS 2013 CATI Questionnaire	N-SSATS 2013 full questionnaire ,   N-SSATS 2013 web screens for on-line questionnaire ,   N-SSATS 2013 CATI Questionnaire
N-SSATS BC	N-SSATS 2014 abbreviated questionnaire	N-SSATS 2014 abbreviated questionnaire

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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	29,440	24,541	0	-421	5,320	0
Annual Time Burden (Hours)	11,535	15,706	0	-4,179	8	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Currently there are 15,706 burden hours in the OMB inventory. SAMHSA is now requesting 11,535 hours. The net decrease of 4,171 hours is due to an 8 hour addition for DASIS adjust-ments and a 4,179 hour decrease due to program changes.

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Annual Cost to Federal Government: $6,400,000

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: 10/23/2012

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