Monitoring Data Collection Tools for the Minority AIDS Initiative (MAI)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Youth Questinnaire Youth Questinnaire	Form and Instruction	New	Available
Form Adult Questinnaire Adult Questinnaire	Form and Instruction	New	Available
Form HIV Testing Retros HIV Testing Retrospective Reporting Tool	Form and Instruction	Removed	Available
Form Indirect Services Indirect Services Outcomes	Form and Instruction	Removed	Available
Form Quarterly Progress Quarterly Progress Report	Form and Instruction	Modified	Available
MAI_MRT_SS_A_11.21.18.docx	Supporting Statement A	Uploaded 2018-11-21	Available
MAI_MRT_SS_B 10.11.18.docx	Supporting Statement B	Uploaded 2018-11-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
234096	Youth Questionnaire	Form and Instruction	New	Youth Questinnaire
234095	Adult Questionnaire	Form and Instruction	New	Adult Questinnaire
219826	HIV Testing Retrospective Reporting Tool	Form and Instruction	Removed	HIV Testing Retrospective Reporting Tool
219825	Indirect Services Outcomes	Form and Instruction	Removed	Indirect Services Outcomes
219824	Quarterly Progress Report	Form and Instruction	Modified	Quarterly Progress Report

ICR Details

OMB Control No: 0930-0357	ICR Reference No: 201811-0930-002
Status: Historical Active	Previous ICR Reference No: 201601-0930-002
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Monitoring Data Collection Tools for the Minority AIDS Initiative (MAI)
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: 03/29/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/27/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2022	36 Months From Approved	05/31/2019
Responses	30,620	0	806
Time Burden (Hours)	7,880	0	2,848
Cost Burden (Dollars)	0	0	0

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Abstract: The Minority AIDS Initiative (MAI) monitoring tools includes both youth and adult questionnaires as well as the quarterly progress report. The target population for the MAI grantees will be at-risk minority adolescents and young adults. All MAI grantees are expected to report their monitoring data using SAMHSA’s Strategic Prevention Framework (SPF) to target minority populations, as well as other high risk groups residing in communities of color with high prevalence of Substance Abuse and HIV/AIDS.

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Authorizing Statute(s): US Code: 5 USC 516 Name of Law: Priority Substance Abuse Prevention Needs of Regional and National Significance
  

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:
	83 FR 39766	08/10/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 59391	11/23/2018
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

IC Title	Form No.	Form Name
Adult Questionnaire	Adult Questinnaire	Adult Questinnaire
HIV Testing Retrospective Reporting Tool	HIV Testing Retrospective Reporting Tool	HIV Testing Retrospective Reporting Tool
Indirect Services Outcomes	Indirect Services Outcomes	Indirect Services Outcomes
Quarterly Progress Report	Quarterly Progress Report	Quarterly Progress Report
Youth Questionnaire	Youth Questinnaire	Youth Questinnaire

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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	30,620	806	0	29,814	0	0
Annual Time Burden (Hours)	7,880	2,848	0	5,032	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Currently, there are 2,848 burden hours in the OMB inventory. The Program is requesting 7,880 burden hours. This increase of 5,032 hours is a program change due to adding the Adult Questionnaire and the Youth Questionnaire to this data collection.

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Annual Cost to Federal Government: $361,202

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

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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: 11/27/2018

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