Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIDA)

Forms and Documents

Document Name	Status
Form 1 Study of Bh-Works Form	New
Form 1 User Survey for In-Home Drug Deactivation System - State and Local Form and Instruction	New
Form 1 User Survey for In-Home Drug Deactivation System - Individuals and Households Form and Instruction	New
Form 1 User Surveys for In-Home Drug Deactivation System -Private (NIDA) Form and Instruction	New
Fast Track Template 2015.doc Supplementary Document	2015-03-19
NIDA FAST TRACK 2015 Supporting Statement B -.doc Supporting Statement B	2015-03-19
NIDA FAST TRACK 2015 Supporting Statement A - .docx Supporting Statement A	2015-03-19

IC Document Collections

IC ID	Document Title	Status
222402	Study of Bh-Works Form	New
217785	User Survey for In-Home Drug Deactivation System - State and Local Form and Instruction	New
217778	User Survey for In-Home Drug Deactivation System - Individuals and Households Form and Instruction	New
217619	User Surveys for In-Home Drug Deactivation System -Private (NIDA) Form and Instruction	New

ICR Details

OMB Control No: 0925-0655	ICR Reference No: 201503-0925-007
Status: Historical Active	Previous ICR Reference No: 201202-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIDA)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/30/2015
	Date Received in OIRA: 03/27/2015
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	36 Months From Approved	04/30/2015
Responses	6,630	0	2,220
Time Burden (Hours)	4,680	0	1,548
Cost Burden (Dollars)	0	0	0

---

Abstract: This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs.

---

Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Customer Satisfaction
  

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 78875	12/31/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 13878	03/17/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
User Survey for In-Home Drug Deactivation System - State and Local	2, 1	Home User Survey ,   Provider Survey
User Survey for In-Home Drug Deactivation System - Individuals and Households	1, 2	Home User Survey ,   Provider Survey
User Surveys for In-Home Drug Deactivation System -Private (NIDA)	2, 1	Home User Survey ,   Provider Survey
Study of Bh-Works	1, 2	Utility and Usability test ,   Questionnaire Focus group

---

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	6,630	2,220	0	4,410	0	0
Annual Time Burden (Hours)	4,680	1,548	0	3,132	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 an extension of a currently approved submission. There are no changes to this submission form from the previously approved submission, except an increase in the burden hours is being requested.

---

Annual Cost to Federal Government: $744,000

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: 03/27/2015

---