Evaluation for the Partnerships for Success Program

Forms and Documents

Document Name	Status
Form Grantee Project Di Grantee Project Director Interview Form and Instruction	New
Form CLI CLI Form and Instruction	New
Form GLI GLI Form and Instruction	New
PEP_SS-B-OMB_3_30_15_FINAL.docx Supporting Statement B	2015-04-02
PEP_SS-A-OMB_3_30_15_FINAL_.docx Supporting Statement A	2015-04-02

IC Document Collections

IC ID	Document Title	Status
214494	Grantee Project Director Interview Form and Instruction	New
214493	CLI Form and Instruction	New
214492	GLI Form and Instruction	New

ICR Details

OMB Control No: 0930-0348	ICR Reference No: 201501-0930-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Evaluation for the Partnerships for Success Program
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: 04/06/2015
	Date Received in OIRA: 01/08/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	36 Months From Approved
Responses	1,081	0	0
Time Burden (Hours)	2,747	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: SAMHSA's Program Evaluation for Prevention Contract (PEP-C) evaluation of SAMHSA's Strategic Prevention Framework (SPF) Partnerships for Success (PFS) programs. PEP-C is scheduled through September 2018 to conduct a national cross-site evaluation of SPF-PFS, which aims to address two of SAMHSA's top substance abuse prevention priorities: underage drinking (UAD; age 12 to 20) and prescription drug misuse and abuse (PDM; age 12 to 25).

---

Authorizing Statute(s): US Code: 42 USC 516 Name of Law: Priority Substance Abuse Prevention Needs of Regional and National Significance
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 64205	10/28/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 78457	12/30/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Grantee Project Director Interview	Grantee Project Director Interview	Grantee Project Director Interview
GLI	GLI	GLI
CLI	CLI	CLI

---

ICR Summary 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	1,081	0	0	1,081	0	0
Annual Time Burden (Hours)	2,747	0	0	2,747	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 data collection.

---

Annual Cost to Federal Government: $779,155

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

---

Common Form ICR:  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:

(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: 01/08/2015

---