Information Collection Request

Pretesting of Substance Abuse Prevention and Treatment and Mental Health Services Communications Messages

ICR 201306-0930-003 · OMB 0930-0196 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Focus Group Protoc "Talk. They Hear You" - Parents Form and Instruction New Available
Form Screening Question National Recovery Month Form and Instruction New Available
Form Screener TALK - Hispanic/Latino Focus Groups Form and Instruction New Repair queued
Form Focus Group Protoc Scott County Indiana Public Service Announcements Form and Instruction New Available
Form Focus Group Protoc Talk - Focus Group Form and Instruction New Available
Form Survey Talk - Survey Form and Instruction New Repair queued
Form Screener National Recovery Month's Public Serive Announcement Form and Instruction New Available
Form SOC Interview Part TA-SOC Form and Instruction New Available
0196 SS-B 6.17.13.doc Supporting Statement B Uploaded 2013-06-17 Available
Trevor Comments - SAMHSA Message Pretesting - 5-13.pdf Supplementary Document Uploaded 2013-06-17 Available
0196 SS-A 6.17.13.doc Supporting Statement A Uploaded 2013-06-20 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
222612 "Talk. They Hear You" - Parents Form and Instruction New
222611 National Recovery Month Form and Instruction New
220171 TALK - Hispanic/Latino Focus Groups Form and Instruction New
219996 Scott County Indiana Public Service Announcements Form and Instruction New
219214 Talk - Focus Group Form and Instruction New
219174 Talk - Survey Form and Instruction New
218991 National Recovery Month's Public Serive Announcement Form and Instruction New
214987 TA-SOC Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2016 36 Months From Approved 09/30/2013
11,700 0 11,700
9,290 0 9,290
0 0 0





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8
table that charts list of burden
IC Title Form No. Form Name
Talk - Focus Group Screener, Focus Group Protocol Focus Group Protocol ,   Screener
Scott County Indiana Public Service Announcements Focus Group Protocol, Screener, Facilitator Guide Focus Group Protocol ,   Screener ,   Facilitator Guide
National Recovery Month's Public Serive Announcement Consent form-guide-scripts, Screener Screener ,   Consent form-guide-scripts
TA-SOC Focus Group Participants, SOC Interview Participants SOC Interview Participants ,   Focus Group Participants
Talk - Survey Survey, Screener Survey ,   Screener
National Recovery Month Screening Questionnaire, Consent Form, Moderator's Guide Screening Questionnaire ,   Moderator's Guide ,   Consent Form
TALK - Hispanic/Latino Focus Groups Guide, Screener Screener ,   Guide
"Talk. They Hear You" - Parents Focus Group Protocol, Consent Form, Screener, Facilitator Guide Focus Group Protocol ,   Screener ,   Consent Form ,   Facilitator Guide

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 11,700 11,700 0 0 0 0
Annual Time Burden (Hours) 9,290 9,290 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No