Rapid Throughput Standardized Evaluation of Transmissible Risk for Substance Use Disorder in Youth (NIDA)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Transmissible Liability Index (TLI) Survey	Form and Instruction	New	Available
Form 1 Dysregulation Inventory Survey	Form and Instruction	New	Available
Form 1 Twin Type and Drug & Alcohol Screening Survey	Form and Instruction	New	Available
Form 1 Twins Consent Form - Parental	Form and Instruction	New	Available
Form 1 Twins Consent Form - Adult	Form and Instruction	New	Available
Form 1 Transmissible Liability Index	Form and Instruction	New	Available
Form 1 Parent Consent Form Survey Fact Sheet	Form and Instruction	New	Available
Attach-14 - NIDA Response to Public Comment - Rapid Throughput Transmissible Risk - _08-01-2014_13-22-14.pdf	Supplementary Document	Uploaded 2014-08-27	Available
SSB - Rapid Throughput Standardized Evaluation of Transmissible Risk for Substance Use Disorder in Youth 8.2014.docx	Supporting Statement B	Uploaded 2014-08-27	Available
Attach-7_Assent_Form_and_Information-Student_Web_Survey.pdf	Supplementary Document	Uploaded 2014-03-19	Available
Attach-5_School_Requirement-Letter_-Participation_Form 8.2014.docx	Supplementary Document	Uploaded 2014-08-27	Available
Attach-3_IRB_Approval_Rutgers_060513.pdf	Supplementary Document	Uploaded 2014-03-19	Available
Attach-2_IRB_Approval_Pitt_PRO13030229.pdf	Supplementary Document	Uploaded 2014-03-19	Available
Attach-1_IRB_Approval_EXACT_Pro00008535.pdf	Supplementary Document	Uploaded 2014-03-19	Available
Attach-7_Assent_Form_and_Information-Student_Web_Survey 8.2014.docx	Supplementary Document	Uploaded 2014-08-27	Available
SSA - Rapid Throughput Standardized EvaluationofTransmissible Risk for Substance Use Disorder in Youth 8.2014.docx	Supporting Statement A	Uploaded 2014-08-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210974	Twins Transmissible Liability Index (TLI) Survey	Form and Instruction	New	Transmissible Liability Index (TLI) Survey
210973	Twins Dysregulation Inventory	Form and Instruction	New	Dysregulation Inventory Survey
210972	Twin type and Drig Alcohol Screening Survey	Form and Instruction	New	Twin Type and Drug & Alcohol Screening Survey
210971	Youths/Parents (Twins) parental or Adult Consent Form	Form and Instruction	New	Twins Consent Form - Parental
210971	Youths/Parents (Twins) parental or Adult Consent Form	Form and Instruction	New	Twins Consent Form - Adult
210970	School Survey Transmissible Liability Index	Form and Instruction	New	Transmissible Liability Index
210969	Parent Consent Form and Survey Fact Sheet	Form and Instruction	New	Parent Consent Form Survey Fact Sheet

ICR Details

OMB Control No: 0925-0702	ICR Reference No: 201403-0925-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No: 21555
Title: Rapid Throughput Standardized Evaluation of Transmissible Risk for Substance Use Disorder in Youth (NIDA)
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: Approved with change	Conclusion Date: 08/29/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/28/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2017	05/31/2016
Responses	12,400	0	0
Time Burden (Hours)	3,093	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National Institute on Drug Abuse, a National Institutes of Health institute, has contracted with EXACT Sport LLC to finalize the development of the Transmissible Liability Index (TLI). The TLI is a psychometric tool for detecting youth at elevated risk for substance use disorder (SUD). The TLI, a web-based platform for assessing risk of SUD, is a highly efficient tool both in terms of the limited time commitment required as well as its low cost. The inexpensive and high efficiency of the TLI for identifying youths in need of prevention, and the strong cost-benefits to society for SUD prevention, portend strong demand for use in a variety of populations including family and social services, schools, mental health facilities, and youth protection agencies.

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Authorizing Statute(s): US Code: 42 USC 6A Name of Law: National Institute on Drug Abuse
  

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 72682	12/03/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 16802	03/26/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Parent Consent Form and Survey Fact Sheet	1, 1	Parent Consent Form Survey Fact Sheet
School Survey Transmissible Liability Index	1	Transmissible Liability Index
Twin type and Drig Alcohol Screening Survey	1	Twin Type and Drug & Alcohol Screening Survey
Twins Dysregulation Inventory	1	Dysregulation Inventory Survey
Twins Transmissible Liability Index (TLI) Survey	1	Transmissible Liability Index (TLI) Survey
Youths/Parents (Twins) parental or Adult Consent Form	1, 1	Twins Consent Form - Adult ,   Twins Consent Form - Parental

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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	12,400	0	0	12,400	0	0
Annual Time Burden (Hours)	3,093	0	0	3,093	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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 ICR.

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Annual Cost to Federal Government: $371,764

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: 03/28/2014

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