Assessment of the Underage Drinking Prevention: Town Hall Meetings Initiative

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Organizer Survey – Organizer Survey – 6 Month Follow-up	Form and Instruction	New	Available
Form Participant Form - Participant Form - Spanish	Form and Instruction	Modified	Available
Form Participant Form - Participant Form - English	Form and Instruction	Modified	Available
Form Organizer Survey Organizer Survey	Form and Instruction	Modified	Available
CommunitiesTalk_OMB_SS-B_10-17-16.docx	Supporting Statement B	Uploaded 2017-01-19	Available
CommunitiesTalk_OMB_SS-A_1-19-17.docx	Supporting Statement A	Uploaded 2017-01-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
225234	Organizer Survey - 6 month Follow Up	Form and Instruction	New	Organizer Survey – 6 Month Follow-up
194189	Participant Form	Form and Instruction	Modified	Participant Form - Spanish
194189	Participant Form	Form and Instruction	Modified	Participant Form - English
182093	Organizer Survey	Form and Instruction	Modified	Organizer Survey

ICR Details

OMB Control No: 0930-0288	ICR Reference No: 201701-0930-002
Status: Historical Active	Previous ICR Reference No: 201309-0930-001
Agency/Subagency: HHS/SAMHSA	Agency Tracking No: 20346
Title: Assessment of the Underage Drinking Prevention: Town Hall Meetings Initiative
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/17/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/19/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	36 Months From Approved	05/31/2017
Responses	5,500	0	6,720
Time Burden (Hours)	583	0	1,113
Cost Burden (Dollars)	0	0	0

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Abstract: SAMHSA/CSAP intends to support annual Town Hall Meetings (THMs). The information collected will be used by SAMHSA/CSAP to help plan for those annual events and to provide technical assistance and training to organizations that sponsor the events. The information will provide a descriptive picture of the nation-wide initiative, and it will indicate how the THMs were received and some factors that may be associated with well-received events.

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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 78610	11/08/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 5588	01/18/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Organizer Survey	Organizer Survey	Organizer Survey
Organizer Survey - 6 month Follow Up	Organizer Survey – 6 Month Follow-up	Organizer Survey – 6 Month Follow-up
Participant Form	Participant Form - English, Participant Form - Spanish	Participant Form - English ,   Participant Form - Spanish

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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	5,500	6,720	0	-1,220	0	0
Annual Time Burden (Hours)	583	1,113	0	-530	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Currently there are 1,113 total burden hours in the OMB inventory. SAMHSA is requesting 582 hours. SAMHSA/CSAP is requesting a decrease of 531 hours due to the following: • Adjustment of -84 hours due to the reduction in the amount of time it will take respondents to complete the Organizer Survey (from 20 to 10 minutes; based on comments from consultations outside the agency), • Program change of -572 hours due to the reduction in the number of respondents to the Organizer Survey (from 2,220 to a sample of 500; due to initiative funding clarifications and to reduce burden on the CBO host-stipend universe [N = 1,500]); and • Program change of 125 hours for the addition of the Organizer Survey – 6 month Follow-up.

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Annual Cost to Federal Government: $37,518

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: 01/19/2017

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