SAMHSA SOAR Web-Based Data Form

Forms and Documents

Document Name	Status
Form Part II SOAR Data Form - Part II Form and Instruction	Modified
Form Part I SOAR Data Form - Part I Form and Instruction	Modified
SOAR Data Form SS-A 12-6-19 FINAL.docx Supporting Statement A	2019-12-06
SOAR Data Form SS-B 11-18-19 FINAL.docx Supporting Statement B	2019-12-03

IC Document Collections

IC ID	Document Title	Status
226017	SOAR Data Form - Part II Form and Instruction	Modified
198968	SOAR Data Form - Part I Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0329	ICR Reference No: 201912-0930-004
Status: Active	Previous ICR Reference No: 201703-0930-002
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: SAMHSA SOAR Web-Based Data Form
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/24/2020
	Date Received in OIRA: 03/04/2020
Terms of Clearance: In the next revision or extension request, SAMHSA shall provide supporting information on whether SAMHSA intends to collect gender or sex in Part 1 (and why it has made that choice, along with the response options), and shall specify how SAMHSA has satisfied the requirements at 5 CFR 1320.8(b)(3).

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2023	36 Months From Approved	05/31/2020
Responses	2,175	0	2,175
Time Burden (Hours)	563	0	563
Cost Burden (Dollars)	0	0	0

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Abstract: SOAR Web-Based Data Form will collect information from case managers to be used to maintain records on Social Security disability benefits applications, as part of the Supplemental Security Income (SSI)/Social Security Disability Insurance (SSDI) Outreach Access and Recovery (SOAR) effort.

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Authorizing Statute(s): US Code: 42 USC 505 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:
	84 FR 66923	12/06/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 12312	03/02/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
SOAR Data Form - Part I	Part I	Part I
SOAR Data Form - Part II	Part II	Part II

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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	2,175	2,175	0	0	0	0
Annual Time Burden (Hours)	563	563	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $52,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 03/04/2020

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