Survey of Current and Alumni SAMHSA Fellows of the Minority Fellowship Program (MFP)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Alumni Fellows Sur Alumni Fellows Survey	Form and Instruction	New	Available
Form Current Fellows Su Current Fellows Survey	Form and Instruction	Modified	Available
Attachment C DSG IRB Exemption Letter.doc	Supplementary Document	Uploaded 2014-08-12	Available
MFP-SS-B_10.28.14.docx	Supporting Statement B	Uploaded 2014-10-30	Available
MFP-SS-A_8.7.14.docx	Supporting Statement A	Uploaded 2014-08-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
212643	Alumni Fellows Survey	Form and Instruction	New
189380	Current Fellows Survey	Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0304	ICR Reference No: 201408-0930-002
Status: Historical Active	Previous ICR Reference No: 200905-0930-002
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Survey of Current and Alumni SAMHSA Fellows of the Minority Fellowship Program (MFP)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/30/2014
	Date Received in OIRA: 08/19/2014
Terms of Clearance: SAMHSA shall include the OMB Control Number on all forms.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	36 Months From Approved
Responses	788	0	0
Time Burden (Hours)	484	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The MFP offers sustained grants to six national behavioral health professional associations: the American Association of Marriage and Family Therapy (AAMFT), the American Nurses Association (ANA), the American Psychiatric Association (ApA), the American Psychological Association (APA), the Council on Social Work Education (CSWE), and, as of August 2012, the National Board for Certified Counselors and Affiliates (NBCC). The associations, in turn, use the grants to provide a wide range of services for MFP Fellows. To date, more than 1,500 MFP Fellows have received financial assistance and other supports enabling them to complete doctoral degrees and other advanced certifications; to engage in postdoctoral behavioral health research and study; to secure career referrals and placement in clinical, academic, or program positions; to address community behavioral health needs; and to rise to positions of leadership and prominence in the following fields: counseling/drug abuse counseling, marriage and family therapy, nursing, psychiatry, psychology, and social work.

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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:
	79 FR 31343	06/02/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 45206	08/04/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Current Fellows Survey	Current Fellows Survey	Current Fellows Survey
Alumni Fellows Survey	Alumni Fellows Survey	Alumni Fellows Survey

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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	788	0	0	788	0	0
Annual Time Burden (Hours)	484	0	0	484	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/reinstatement.

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Annual Cost to Federal Government: $103,483

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: 08/19/2014

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