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

Forms and Documents

Document Name	Status
Form Alumni Fellows Sur Alumni Fellows Survey Form and Instruction	Modified
Form Current Fellows Su Current Fellows Survey Form and Instruction	Modified
MFP-SS-B_12.17.15.docx Supporting Statement B	2016-03-18
MFP-SS-A_3.17.16.docx Supporting Statement A	2016-03-18

IC Document Collections

IC ID	Document Title	Status
212643	Alumni Fellows Survey Form and Instruction	Modified
189380	Current Fellows Survey Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0304	ICR Reference No: 201603-0930-007
Status: Historical Active	Previous ICR Reference No: 201408-0930-002
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: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/01/2016
	Date Received in OIRA: 03/18/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	36 Months From Approved	10/31/2017
Responses	1,868	0	788
Time Burden (Hours)	1,260	0	484
Cost Burden (Dollars)	0	0	0

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Abstract: The current SAMHSA MFP Fellows currently receiving support during their master’s-level program, doctoral-level training or psychiatric residency will be asked about their experiences in the MFP (from recruitment into the program through their participation in the various activities provided by the Grantees). The MFP Alumni who participated in the MFP during the time the program was administered by SAMHSA will be asked about their previous experiences as Fellows in the MFP and also about their subsequent involvement and leadership in their professions.

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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:
	81 FR 1196	01/11/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 14456	03/17/2016
Did the Agency receive public comments on this ICR? No

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

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

	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	1,868	788	0	1,080	0	0
Annual Time Burden (Hours)	1,260	484	0	776	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: Currently there are 484 burden hours in the OMB inventory. SAMHSA is now requesting 1,260 hours. The increase of 776 hours is due to a program change for the time needed for the current and alumni Fellows to complete the additional survey questions, which are estimated to add 5 minutes to each survey’s completion time, and the result of including the NITT-MFP-Y and NITT-MFP-AC Fellows (up to 300 current Fellows and up to 780 alumni Fellows) into the respondent pool.

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Annual Cost to Federal Government: $41,967

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: 03/18/2016

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