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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Facilitator Guide Facilitator Guide	Form and Instruction	New	Repair queued
Form Consent Form Consent Form	Form and Instruction	New	Available
Form Screener Screener	Form and Instruction	New	Available
Form Focus Group Protoc Focus Group Protocol	Form and Instruction	New	Available
Form Consent Form Consent Form	Form and Instruction	New	Available
Form Moderator's Guide Moderator's Guide	Form and Instruction	New	Available
Form Screening Question Screening Questionnaire	Form and Instruction	New	Available
Form Guide Guide	Form and Instruction	New	Available
Form Screener Screener	Form and Instruction	New	Repair queued
Form Facilitator Guide Facilitator Guide	Form and Instruction	New	Available
Form Screener Screener	Form and Instruction	New	Available
Form Focus Group Protoc Focus Group Protocol	Form and Instruction	New	Available
Form Screener Screener	Form and Instruction	New	Available
Form Focus Group Protoc Focus Group Protocol	Form and Instruction	New	Available
Form Screener Screener	Form and Instruction	New	Available
Form Survey Survey	Form and Instruction	New	Repair queued
Form Consent form-guide Consent form-guide-scripts	Form and Instruction	New	Available
Form Screener Screener	Form and Instruction	New	Available
Form Focus Group Partic Focus Group Participants	Form and Instruction	New	Available
Form SOC Interview Part SOC Interview Participants	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 ID	Collection	Type	Status	Form
222612	"Talk. They Hear You" - Parents	Form and Instruction	New	Facilitator Guide
222612	"Talk. They Hear You" - Parents	Form and Instruction	New	Consent Form
222612	"Talk. They Hear You" - Parents	Form and Instruction	New	Screener
222612	"Talk. They Hear You" - Parents	Form and Instruction	New	Focus Group Protocol
222611	National Recovery Month	Form and Instruction	New	Consent Form
222611	National Recovery Month	Form and Instruction	New	Moderator's Guide
222611	National Recovery Month	Form and Instruction	New	Screening Questionnaire
220171	TALK - Hispanic/Latino Focus Groups	Form and Instruction	New	Guide
220171	TALK - Hispanic/Latino Focus Groups	Form and Instruction	New	Screener
219996	Scott County Indiana Public Service Announcements	Form and Instruction	New	Facilitator Guide
219996	Scott County Indiana Public Service Announcements	Form and Instruction	New	Screener
219996	Scott County Indiana Public Service Announcements	Form and Instruction	New	Focus Group Protocol
219214	Talk - Focus Group	Form and Instruction	New	Screener
219214	Talk - Focus Group	Form and Instruction	New	Focus Group Protocol
219174	Talk - Survey	Form and Instruction	New	Screener
219174	Talk - Survey	Form and Instruction	New	Survey
218991	National Recovery Month's Public Serive Announcement	Form and Instruction	New	Consent form-guide-scripts
218991	National Recovery Month's Public Serive Announcement	Form and Instruction	New	Screener
214987	TA-SOC	Form and Instruction	New	Focus Group Participants
214987	TA-SOC	Form and Instruction	New	SOC Interview Participants

ICR Details

OMB Control No: 0930-0196	ICR Reference No: 201306-0930-003
Status: Historical Active	Previous ICR Reference No: 201008-0930-002
Agency/Subagency: HHS/SAMHSA	Agency Tracking No: 19809
Title: Pretesting of Substance Abuse Prevention and Treatment and Mental Health Services Communications Messages
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/18/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/26/2013
Terms of Clearance: Previous terms of clearance apply: This request for a generic clearance of pretesting materials is approved. Consistent with other generic clearances, HHS/SAMHSA will submit each individual pretest for OMB review, along with a brief description of the purpose of the pretest, sample design if applicable, any respondent incentives planned, and individual burden.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2016	36 Months From Approved	09/30/2013
Responses	11,700	0	11,700
Time Burden (Hours)	9,290	0	9,290
Cost Burden (Dollars)	0	0	0

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Abstract: This submission is for generic approval for pretesting of educational and information materials for various consumer publics and the professional communities in the areas of substance abuse prevention, addiction treatment, and mental health services. To assure that brochures, posters, information kits, public service announcements, videos news releases, web site and direct response messages communicate their messages effectively to the intended components of the population it is essential to pretest them to assure that they are received, understood, and accepted by those for whom they are intended.

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Authorizing Statute(s): US Code: 42 USC 501 Name of Law: SAMHSA
  

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:
	78 FR 21382	04/03/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 36203	06/17/2013
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
"Talk. They Hear You" - Parents	Focus Group Protocol, Consent Form, Screener, Facilitator Guide	Focus Group Protocol ,   Screener ,   Consent Form ,   Facilitator Guide
National Recovery Month	Screening Questionnaire, Consent Form, Moderator's Guide	Screening Questionnaire ,   Moderator's Guide ,   Consent Form
National Recovery Month's Public Serive Announcement	Consent form-guide-scripts, Screener	Screener ,   Consent form-guide-scripts
Scott County Indiana Public Service Announcements	Focus Group Protocol, Screener, Facilitator Guide	Focus Group Protocol ,   Screener ,   Facilitator Guide
TA-SOC	Focus Group Participants, SOC Interview Participants	SOC Interview Participants ,   Focus Group Participants
TALK - Hispanic/Latino Focus Groups	Guide, Screener	Screener ,   Guide
Talk - Focus Group	Screener, Focus Group Protocol	Focus Group Protocol ,   Screener
Talk - Survey	Survey, Screener	Survey ,   Screener

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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	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

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: There is no burden change.

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Annual Cost to Federal Government: $305,000

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: 06/26/2013

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