Additional Infromation for the FY 2016-17 Uniform BG Application

ICR 201611-0930-001

OMB: 0930-0370

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Supporting Statement A
2016-11-29
IC Document Collections
IC ID
Document
Title
Status
224633 New
ICR Details
0930-0370 201611-0930-001
Historical Active
HHS/SAMHSA
Additional Infromation for the FY 2016-17 Uniform BG Application
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 01/23/2017
Retrieve Notice of Action (NOA) 12/01/2016
  Inventory as of this Action Requested Previously Approved
01/31/2020 36 Months From Approved
60 0 0
2,400 0 0
0 0 0

The amendment is to gather information regarding the states’ and jurisdictions’ plans to implement elements of a syringe services program at 1 or more community-based organizations that receive amounts from the grant to provide substance use disorder treatment and recovery services to persons who inject drugs.

US Code: 42 USC 1932 Name of Law: Application for Grant; Approval of State Plan
  
None

Not associated with rulemaking

  81 FR 64183 09/19/2016
81 FR 85983 11/29/2016
No

1
IC Title Form No. Form Name
Uniform BG Application Amendment Application Application

  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 60 0 0 60 0 0
Annual Time Burden (Hours) 2,400 0 0 2,400 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new data collection.

$36,131
No
No
No
No
No
Uncollected
Summer King 2402761243

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/01/2016


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