Participant Feedback Forms for the Mental Health Care Provider Education (MHCPE) in the HIV/AIDS Program

ICR 201403-0930-002

OMB: 0930-0195

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Supporting Statement B
2014-03-05
Supporting Statement A
2014-03-05
ICR Details
0930-0195 201403-0930-002
Historical Active 201012-0930-001
HHS/SAMHSA 21539
Participant Feedback Forms for the Mental Health Care Provider Education (MHCPE) in the HIV/AIDS Program
Revision of a currently approved collection   No
Regular
Approved without change 05/29/2014
Retrieve Notice of Action (NOA) 03/13/2014
The agency will not collect social security numbers or partial social security numbers as part of this collection.
  Inventory as of this Action Requested Previously Approved
05/31/2017 36 Months From Approved 05/31/2014
12,600 0 12,600
1,843 0 1,843
0 0 0

These standardized forms will collect systematic feedback from trainees participating in the Minority HIV/AIDS Mental Health Treatment and Education Services Program and the Mental Health Care Provider Education in HIV/AIDS III Program. The overall goal of the two programs is to help create a cadre of traditional and non-traditional mental health service providers who utilize state-of-the-art information on the psychological and neuropsychological sequelae of HIV/AIDS, and to enhance the nation's ability to have an impact on the HIV/AIDS epidemic.

None
None

Not associated with rulemaking

  78 FR 78374 12/26/2013
79 FR 12206 03/04/2014
No

5
IC Title Form No. Form Name
Session Report Form All IC Forms All IC Forms
Participant Feedback Form Forms in IC-1 Forms in IC-1
Neuropsychiatric Participant Feedback Forms in IC-1 Forms in IC-1
Adherence Participant Feedback Form Forms in IC-1 Forms in IC-1
Ethics Participant Feedback Form Forms in IC-1 Forms in IC-1

  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 12,600 12,600 0 0 0 0
Annual Time Burden (Hours) 1,843 1,843 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$395,000
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Summer King 2402761243

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/13/2014


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