SAMHSA SOAR Web-Based Data Form

Forms and Documents

Document	Type	Status	Availability
Form Part II SOAR Data Form - Part II	Form and Instruction	New	Repair queued
Form Part I SOAR Data Form - Part I	Form and Instruction	Modified	Repair queued
SOAR Data Form SS-B 3.10.16.docx	Supporting Statement B	Uploaded 2016-07-27	Available
SOAR Data Form SS-A 7.27.16.docx	Supporting Statement A	Uploaded 2016-07-27	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
226017	SOAR Data Form - Part II	Form and Instruction	New
198968	SOAR Data Form - Part I	Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0329	ICR Reference No: 201703-0930-002
Status: Historical Active	Previous ICR Reference No: 201607-0930-003
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: SAMHSA SOAR Web-Based Data Form
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: 05/18/2017
	Date Received in OIRA: 03/09/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	36 Months From Approved	09/30/2019
Responses	2,175	0	2,100
Time Burden (Hours)	563	0	525
Cost Burden (Dollars)	0	0	0

---

Abstract: SOAR Web-Based Data Form will collect information from case managers to be used to maintain records on Social Security disability benefits applications, as part of the Supplemental Security Income (SSI)/Social Security Disability Insurance (SSDI) Outreach Access and Recovery (SOAR) effort.

---

Authorizing Statute(s): US Code: 42 USC 505 Name of Law: Data Collection
  

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:
	81 FR 91943	12/19/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 12981	03/08/2017
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
SOAR Data Form - Part II	Part II	Part II
SOAR Data Form - Part I	Part I	Part I

---

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	2,175	2,100	0	75	0	0
Annual Time Burden (Hours)	563	525	0	38	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 525 hours in the OMB inventory. SAMHSA is requesting 562.50 total hours. The program change of 37 hours is due to the number of additional questions and the fact that they will only require a once annual response from approximately 75 users. The new questions will represent .50 hour of burden per respondent each year with only 75 respondents estimated each year for this additional set of questions.

---

Annual Cost to Federal Government: $52,000

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: 03/09/2017

---