State Targeted Response to the Opioid Crisis Grant Program Reports

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Tables A-E Performance Report	Form and Instruction	Modified	Available
Opioid STR OMB SS-B 8.13.18.docx	Supporting Statement B	Uploaded 2018-10-16	Available
Opioid STR OMB SS-A 8.13.18.docx	Supporting Statement A	Uploaded 2018-10-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227370	Performance Report	Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0378	ICR Reference No: 201810-0930-003
Status: Active	Previous ICR Reference No: 201707-0930-002
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: State Targeted Response to the Opioid Crisis Grant Program Reports
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: 03/14/2019
	Date Received in OIRA: 10/17/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2021	36 Months From Approved	09/30/2020
Responses	114	0	114
Time Burden (Hours)	969	0	912
Cost Burden (Dollars)	0	0	0

---

Abstract: There are 57 (states and jurisdictions) award recipients in this program. All funded states and jurisdictions will be asked to report on their implementation and performance through an online data collection system. Award recipients will report performance on the following measures specific to this program: number of people who receive OUD treatment, number of people who receive OUD recovery services, number of providers implementing medication-assisted treatment, and the number of OUD prevention and treatment providers trained, to include NPs, PAs, as well as physicians, nurses, counselors, social workers, case managers, etc. This information will be collected at the mid-point and conclusion of each grant award year. Additionally, each award recipient will describe the purposes for which the grant funds received were expended and the activities under the program, and the ultimate recipients of amounts provided to the grantee in the grants.

---

Authorizing Statute(s): PL: Pub.L. 114 - 255 1003 Name of Law: 21st Century Cures Act
  

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:
	83 FR 39765	08/10/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 52226	10/16/2018
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Performance Report	Tables A-E	Tables A-E

---

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	114	114	0	0	0	0
Annual Time Burden (Hours)	969	912	0	57	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 912 burden hours in the OMB inventory. SAMHSA is requesting 969 total burden hours. The request to increase the burden by 57 hours is due to the inclusion of Table E which was omitted from the original submission.

---

Annual Cost to Federal Government: $322,626

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: 10/17/2018

---