National System of Care (SOC) Expansion Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Child and Family Child and Family	Form and Instruction	New	Available
Form Benchmarking Tool Benchmarking Tool	Form and Instruction	New	Available
Form Financial Mapping Financial Mapping Interview	Form and Instruction	New	Available
Form GIS GIS	Form and Instruction	New	Available
Form Network Analysis S Network Analysis Survey	Form and Instruction	New	Available
Form SOCEA SOCEA	Form and Instruction	New	Available
Form SAIS SAIS	Form and Instruction	New	Available
Form Stakeholder Interv Stakeholder Interviews	Form and Instruction	New	Available
OMB SS-B 3-30-15.docx	Supporting Statement B	Uploaded 2015-04-02	Available
OMB SS-A 3-30-15.docx	Supporting Statement A	Uploaded 2015-04-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214520	Child and Family Instruments	Form and Instruction	New	Child and Family
214519	Benchmark Tool	Form and Instruction	New	Benchmarking Tool
214518	Financcial Mapping Interview	Form and Instruction	New	Financial Mapping Interview
214515	GIS	Form and Instruction	New	GIS
214514	Network Anaylsis Survey	Form and Instruction	New	Network Analysis Survey
214513	SOCEA	Form and Instruction	New	SOCEA
214512	SAIS	Form and Instruction	New	SAIS
214511	Stakeholder Interviews	Form and Instruction	New	Stakeholder Interviews

ICR Details

OMB Control No: 0930-0349	ICR Reference No: 201501-0930-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: National System of Care (SOC) Expansion Evaluation
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 without change	Conclusion Date: 04/28/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/08/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	36 Months From Approved
Responses	56,672	0	0
Time Burden (Hours)	11,959	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National SOC Expansion Evaluation reflects the transition of CMHI from an innovative community-based demonstration program to one that is expanding its scope or geographic reach to larger regions such as states, multi-county areas, tribes and territories. This evolution reflects SAMHSA's Theory of Change Model that takes the development of an intervention through the phases of innovation, translation, dissemination, implementation and wide scale adoption .

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Authorizing Statute(s): US Code: 42 USC 565 Name of Law: General Provisions - Evaluations and Reports
  

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 59498	10/02/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 78095	12/29/2014
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
Benchmark Tool	Benchmarking Tool	Benchmarking Tool
Child and Family Instruments	Child and Family	Child and Family
Financcial Mapping Interview	Financial Mapping Interview	Financial Mapping Interview
GIS	GIS	GIS
Network Anaylsis Survey	Network Analysis Survey	Network Analysis Survey
SAIS	SAIS	SAIS
SOCEA	SOCEA	SOCEA
Stakeholder Interviews	Stakeholder Interviews	Stakeholder Interviews

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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	56,672	0	0	56,672	0	0
Annual Time Burden (Hours)	11,959	0	0	11,959	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.

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Annual Cost to Federal Government: $1,413,279

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: 01/08/2015

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