Evaluation of Medication- Assisted Treatment (MAT) for Opioid Use Disorders Study

Forms and Documents

Document Name	Status
Client questionnaire - 24 month follow-up Form	New
Client questionnaire - 12 month follow-up Form	New
Client Questionnaire - baseline Form	New
Client Check-in Questionnaire Form	New
Client Screener Form	New
Attachment 10 IRB Documents 17ACE_MAT.PDF Supplementary Document	2018-02-12
Att. 14_CoC for MAT Study.pdf Supplementary Document	2018-02-12
Att 6a. SSN collection.pdf Supplementary Document	2018-02-12
SSA_MAT_Clean_2.08.18.docx Supporting Statement A	2018-02-12
Signed CoC for study titled MAT Study.pdf Supplementary Document	2017-11-08
SSB_MAT_Clean_2.08.18.docx Supporting Statement B	2018-02-12
Attachment 13 Staff (Provider) Focus Group Consent 17ACE_MAT.docx Supplementary Document	2017-11-08
Attachment 12 Client Informed Consent_17ACE_MAT.docx Supplementary Document	2017-11-08
Attachment 11 Client Supporting Documents 17ACE_MAT.docx Supplementary Document	2017-11-08
Attachment 10 IRB Documents 17ACE_MAT.pdf Supplementary Document	2017-11-08
Attachment 9 Privacy Impact Assessment 17ACE_MAT.pdf Supplementary Document	2017-11-08
Attachment 2 60 Day FRN 17ACE_MAT.pdf Supplementary Document	2017-11-08
Attachment 1 Authorizing Legislation.docx Supplementary Document	2017-11-08

IC Document Collections

IC ID	Document Title	Status
228981	Treatment Facility Staff Focus Groups Other-Focus group guide	New
228980	Client Focus Groups Other-Focus group guide	New
228979	Client questionnaire - 24 month follow-up Form	New
228978	Client questionnaire - 12 month follow-up Form	New
228977	Client Questionnaire - baseline Form	New
228976	Client Check-in Questionnaire Form	New
228975	Client Screener Form	New

ICR Details

OMB Control No: 0920-1218	ICR Reference No: 201711-0920-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-17ACE
Title: Evaluation of Medication- Assisted Treatment (MAT) for Opioid Use Disorders Study
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 with change	Conclusion Date: 02/12/2018
	Date Received in OIRA: 12/07/2017
Terms of Clearance: Approved consistent with the understanding that CDC will continue to coordinate opioid research efforts and outcomes with partners both within HHS and external (SAMHSA, NIH/NIDA, FDA)

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved
Responses	6,871	0	0
Time Burden (Hours)	3,093	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Conduct an epidemiologic study to assess the real-world client outcomes of three types of Medication Assisted Treatment (MAT) and counseling without medication for individuals with Opioid Use Disorder (OUD). This study will also examine the contextual, provider, and individual factors that influence treatment implementation and client outcomes.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

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 27832	06/19/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 57757	12/07/2017
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
Client Questionnaire - baseline	none, none	Client questionnaire - baseline - Spanish ,   Client questionnaire - baseline English
Client questionnaire - 12 month follow-up	none, none	Client questionnaire - 12 month follow up - Spanish ,   Client questionnaire - 12 month follow-up - English
Client Screener	none	Client Screener
Client Focus Groups
Client questionnaire - 24 month follow-up	none, none	Client questionnaire - 24 month follow-up - Spanish ,   Client questionnaire - 24 month follow-up - English
Treatment Facility Staff Focus Groups
Client Check-in Questionnaire	none, none	Check-in Questionnaire - English ,   Client Check-in Questionnaire - Spanish

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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	6,871	0	0	6,871	0	0
Annual Time Burden (Hours)	3,093	0	0	3,093	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 ICR.

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Annual Cost to Federal Government: $1,940,535

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.     Yes

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.     Yes

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: 12/07/2017

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