CABHI Evaluation Client & Stakeholder Surveys

Forms and Documents

Document Name	Status
Form Stakeholder Survey Stakeholder Survey Form and Instruction	Modified
Form 6-Month Followup 6-Month Followup Form and Instruction	Modified
Form Baseline Baseline Form and Instruction	Modified
0930_0320_OMB Supporting Statement_B 3.8.17.docx Supporting Statement B	2017-05-10
0930_0320_OMB Supporting Statement_A 5.10.17.docx Supporting Statement A	2017-05-10

IC Document Collections

IC ID	Document Title	Status
195856	Stakeholder Survey Form and Instruction	Modified
195855	6-Month Followup Form and Instruction	Modified
195854	Baseline Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0320	ICR Reference No: 201705-0930-002
Status: Historical Active	Previous ICR Reference No: 201403-0930-005
Agency/Subagency: HHS/SAMHSA	Agency Tracking No: 21577
Title: CABHI Evaluation Client & Stakeholder Surveys
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: 06/27/2017
	Date Received in OIRA: 05/12/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved	06/30/2017
Responses	11,269	0	11,241
Time Burden (Hours)	5,098	0	4,006
Cost Burden (Dollars)	0	0	0

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Abstract: This collection was previously known as the Cross-Site Evaluation for the Grants for the Benefit of Homeless Individuals (GBHI), but is now known as the CABHI Evaluation Client & Stakeholder Surveys. These data collection activities, focused on project clients and stakeholders. The information collected through all three surveys (Baseline and 6-month Followup, and Stakeholder Survey) will provide the data necessary to conduct a complete structure, process, outcome, and cost evaluation. CABHI emphasizes the value of providing access to permanent housing and supportive services for people who are chronically homeless and have mental disorders, substance use disorders, or both. It enhances and extends the GBHI and SSH efforts by focusing on the development and expansion of local infrastructures that integrate treatment and services for mental and substance use disorders, permanent housing, and other critical services for individuals experiencing chronic homelessness.

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Authorizing Statute(s): US Code: 42 USC 290 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:
	82 FR 13641	03/14/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 22148	05/12/2017
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Baseline	Baseline	Baseline
6-Month Followup	6-Month Followup	6-Month Followup
Stakeholder Survey	Stakeholder Survey_Wave3, Stakeholder Survey_Wave1, Stakeholder Survey_Wave2	Stakeholder Survey_Wave1 ,   Stakeholder Survey_Wave2 ,   Stakeholder Survey_Wave3

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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	11,269	11,241	0	132	-104	0
Annual Time Burden (Hours)	5,098	4,006	0	139	953	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 4,006 total burden hours in the OMB inventory. SAMHSA is requesting 5,098; an increase of 1,092 hours. This is due to the response burden times have been revised to reflect real-world experience during the Homeless Programs evaluation. Additionally, for the Stakeholder Survey, up to 78 grantees are expected to participate each year in the evaluation.

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Annual Cost to Federal Government: $1,450,552

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: 05/12/2017

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