Common Data Platform

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CSAT Aggregate Too CSAT Aggregate Tool	Form	Unchanged	Available
Form IPP_RESULT FORM IPP_RESULT FORM	Form	Unchanged	Available
Form CSAT Instrument CSAT Instrument	Form and Instruction	Modified	Available
Form CSAP Adult CSAP Adult	Form and Instruction	Modified	Available
Form CSAP Youth CSAP Youth	Form and Instruction	Modified	Available
Form CMHS Instrument CMHS Instrument	Form and Instruction	Modified	Available
Form CoC Questions CoC Questions	Form and Instruction	Modified	Available
Form PBHCI SECTION H PBHCI SECTION H	Form and Instruction	Modified	Available
Justification-Change.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-01-13	Available
SS-CDP-B__10 3 14.docx	Supporting Statement B	Uploaded 2014-10-06	Available
SS-CDP-A_ 12 19 14.docx	Supporting Statement A	Uploaded 2014-12-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213390	CSAT - Program-Level Data	Form	Unchanged	CSAT Aggregate Tool
213385	CMHS Program-Level Data	Form	Unchanged	IPP_RESULT FORM
213384	CSAT Client-Level Data	Form and Instruction	Modified	CSAT Instrument
213380	CSAP Client-Level Data	Form and Instruction	Modified	CSAP Adult
213380	CSAP Client-Level Data	Form and Instruction	Modified	CSAP Youth
213379	CMHS Client -Level Data	Form and Instruction	Modified	CMHS Instrument
213379	CMHS Client -Level Data	Form and Instruction	Modified	CoC Questions
213379	CMHS Client -Level Data	Form and Instruction	Modified	PBHCI SECTION H

ICR Details

OMB Control No: 0930-0346	ICR Reference No: 201501-0930-004
Status: Historical Active	Previous ICR Reference No: 201410-0930-001
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Common Data Platform
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/14/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/13/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	12/31/2017	12/31/2017
Responses	1,408,864	0	1,408,864
Time Burden (Hours)	381,566	0	381,566
Cost Burden (Dollars)	0	0	0

---

Abstract: The CDP application collects and reports data and outcomes relating to treatment and prevention grants awarded by SAMHSA to its external partners. This information is collected using a client tool that provides the capacity to report for all of the discretionary programs. In particular, SAMHSA may report the following: types of populations served, numbers of people served, and number of people served by demographic characteristics; types and locations of particular activities supported; effectiveness across programs for particular populations; characteristics and effectiveness across programs of activities relative to national, subpopulation and geographic area; and trends.

---

Authorizing Statute(s): US Code: 42 USC 1105 Name of Law: GPRA
  

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 40765	07/14/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 59494	10/02/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
CMHS Client -Level Data	CMHS Instrument, CoC Questions , PBHCI SECTION H	PBHCI SECTION H ,   CoC Questions ,   CMHS Instrument
CMHS Program-Level Data	IPP_RESULT FORM	IPP_RESULT FORM
CSAP Client-Level Data	CSAP Adult , CSAP Youth	CSAP Youth ,   CSAP Adult
CSAT - Program-Level Data	CSAT Aggregate Tool	CSAT Aggregate Tool
CSAT Client-Level Data	CSAT Instrument	CSAT Instrument

---

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	1,408,864	1,408,864	0	0	0	0
Annual Time Burden (Hours)	381,566	381,566	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $5,360,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 01/13/2015

---