State Targeted Response to the Opioid Crisis (Opioid STR) Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form GPRA Client Outcom GPRA Client Outcome Measures Tool	Form and Instruction	New	Available
Form GPRA Client Outcom GPRA Client Outcome Measures Tool	Form and Instruction	New	Available
Form GPRA Client Outcom GPRA Client Outcome Measures Tool	Form and Instruction	New	Available
Form Community-Program Community-Program Director Time 3	Form and Instruction	New	Available
Form Community-Program Community-Program Director Time 2	Form and Instruction	New	Available
Form Community-Program Community-Program Director Baseline	Form and Instruction	New	Available
Form Community-Program Community-Program Data Manager Time 2	Form and Instruction	New	Available
Form Community-Program Community-Program Clinical Staff Time 2	Form and Instruction	New	Available
Form Community-Program Community-Program Director Time 2	Form and Instruction	New	Available
Form Community-Program Community-Program Data Manager Baseline	Form and Instruction	New	Available
Form Community-Program Community-Program Clinical Staff Baseline	Form and Instruction	New	Available
Form Community-Program Community-Program Director Baseline	Form and Instruction	New	Available
Form State Director Tim State Director Time 2 Interview Protocol	Form and Instruction	New	Available
Form State Director Tim State Director Time 1 Interview Protocol	Form and Instruction	New	Available
Form State Director Tim State Director Time 3 Survey	Form and Instruction	New	Available
Form State Director Tim State Director Time 2 Survey	Form and Instruction	New	Available
Form State Director Bas State Director Baseline Survey	Form and Instruction	New	Available
Opioid STR OMB SS-B 7.6.17.docx	Supporting Statement B	Uploaded 2017-07-06	Available
Opioid STR OMB SS-A 7.6.17.docx	Supporting Statement A	Uploaded 2017-07-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227390	Client-level Data for Community Program Level - Discharge	Form and Instruction	New	GPRA Client Outcome Measures Tool
227389	Client-level Data for Community Program Level - Follow-up	Form and Instruction	New	GPRA Client Outcome Measures Tool
227388	Client-level Data for Community Program Level - Baseline	Form and Instruction	New	GPRA Client Outcome Measures Tool
227386	Community Program Director - Time 3	Form and Instruction	New	Community-Program Director Time 3
227384	Community Program Director - Time 2	Form and Instruction	New	Community-Program Director Time 2
227383	Community Program Director - Baseline	Form and Instruction	New	Community-Program Director Baseline
227382	Community Program Data Manager - Time 2	Form and Instruction	New	Community-Program Data Manager Time 2
227381	Community Program Clinical Staff - Time 2	Form and Instruction	New	Community-Program Clinical Staff Time 2
227380	Community Program Clinical Staff - Time 2	Form and Instruction	New	Community-Program Director Time 2
227379	Community Program Data Manager - Baseline	Form and Instruction	New	Community-Program Data Manager Baseline
227377	Community Program Clinical Staff - Baseline	Form and Instruction	New	Community-Program Clinical Staff Baseline
227376	Community Program Director - Baseline	Form and Instruction	New	Community-Program Director Baseline
227375	State Interview protocol - Time 2	Form and Instruction	New	State Director Time 2 Interview Protocol
227374	State Interview Protocol - Time 1	Form and Instruction	New	State Director Time 1 Interview Protocol
227373	State Survey - Time 3	Form and Instruction	New	State Director Time 3 Survey
227372	State Survey - Time 2	Form and Instruction	New	State Director Time 2 Survey
227371	State Survey - Baseline	Form and Instruction	New	State Director Baseline Survey

ICR Details

OMB Control No: 0930-0379	ICR Reference No: 201707-0930-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: State Targeted Response to the Opioid Crisis (Opioid STR) Evaluation
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/11/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/06/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2020	36 Months From Approved
Responses	2,905	0	0
Time Burden (Hours)	2,602	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: SAMHSA recently awarded 57 grants to states and territories to help address the national opioid crisis by increasing access to treatment, reducing unmet treatment needs, and reducing opioid overdose related deaths through the provision of prevention, treatment, and recovery activities for opioid use disorder (OUD). SAMHSA will be conducting a cross-site evaluation of the Opioid STR grant program. The proposed data collection is necessary to evaluate how the Opioid STR state/territory grantees plan and implement prevention, treatment and recovery services. Additionally, a subset of communities/programs will be selected to participate in supplemental evaluation activities designed to provide detailed information related to the implementation of services at the program/community level, as well as the impacts of the program on client outcomes.

---

Authorizing Statute(s): US Code: 42 USC 509D Name of Law: Priority Substance Abuse Treatment Needs of Regional and National Significance
  

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:
	82 FR 18662	04/20/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 31338	07/06/2017
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 17

table that charts list of burden

IC Title	Form No.	Form Name
Client-level Data for Community Program Level - Baseline	GPRA Client Outcome Measures Tool	GPRA Client Outcome Measures Tool
Client-level Data for Community Program Level - Discharge	GPRA Client Outcome Measures Tool	GPRA Client Outcome Measures Tool
Client-level Data for Community Program Level - Follow-up	GPRA Client Outcome Measures Tool	GPRA Client Outcome Measures Tool
Community Program Clinical Staff - Baseline	Community-Program Clinical Staff Baseline	Community-Program Clinical Staff Baseline
Community Program Clinical Staff - Time 2	Community-Program Clinical Staff Time 2	Community-Program Clinical Staff Time 2
Community Program Clinical Staff - Time 2	Community-Program Director Time 2	Community-Program Director Time 2
Community Program Data Manager - Baseline	Community-Program Data Manager Baseline	Community-Program Data Manager Baseline
Community Program Data Manager - Time 2	Community-Program Data Manager Time 2	Community-Program Data Manager Time 2
Community Program Director - Baseline	Community-Program Director Baseline	Community-Program Director Baseline
Community Program Director - Baseline	Community-Program Director Baseline	Community-Program Director Baseline
Community Program Director - Time 2	Community-Program Director Time 2	Community-Program Director Time 2
Community Program Director - Time 3	Community-Program Director Time 3	Community-Program Director Time 3
State Interview Protocol - Time 1	State Director Time 1 Interview Protocol	State Director Time 1 Interview Protocol
State Interview protocol - Time 2	State Director Time 2 Interview Protocol	State Director Time 2 Interview Protocol
State Survey - Baseline	State Director Baseline Survey	State Director Baseline Survey
State Survey - Time 2	State Director Time 2 Survey	State Director Time 2 Survey
State Survey - Time 3	State Director Time 3 Survey	State Director Time 3 Survey

---

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	2,905	0	0	2,905	0	0
Annual Time Burden (Hours)	2,602	0	0	2,602	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: This is a new data collection.

---

Annual Cost to Federal Government: $1,099,042

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 07/06/2017

---