NHE Demo Opioid Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Participant Consent Form.docx	Supplementary Document	Uploaded 2020-01-23	Available
CEO Statistical Review Clearance Form_NHE Grants_(2019_1127).pdf	Supplementary Document	Uploaded 2019-12-12	Available
NHE OMB Part B_Final_rev.docx	Supporting Statement B	Uploaded 2020-11-16	Available
1290-0NEW Supporting Statement A NHE Demo_FINAL_rev.docx	Supporting Statement A	Uploaded 2020-11-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
238910	Participant Focus Group Information Form	Other-Focus Group Background Information Form	New
238909	NHE Focus Group Protocol	Other-Focus Group Protocol	New
238908	Interview Respondent Info Form	Other-Background Information Form	New
238869	Semi-structured program stakeholder interview protocol	Other-Interview Protocol	New

ICR Details

OMB Control No: 1290-0033	ICR Reference No: 201912-1290-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: DOL/OS	Agency Tracking No:
Title: NHE Demo Opioid 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 with change	Conclusion Date: 11/16/2020
	Date Received in OIRA: 09/17/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2023	36 Months From Approved
Responses	160	0	0
Time Burden (Hours)	117	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is a CEO/DOL Evaluation: The U.S. Department of Labor’s (DOL’s) Chief Evaluation Office has commissioned an evaluation of the National Health Emergency (NHE) Dislocated Worker Demonstration Grants to Address the Opioid Crisis. These grants enable states to test innovative approaches to address the economic and workforce-related impacts of the opioid epidemic. The evaluation of the NHE Grants to Address the Opioid Crisis offers a unique opportunity to build knowledge about the implementation of these approaches, identify perceived challenges and promising practices, and share information with grantees and other stakeholders as they seek to address the opioid crisis

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Authorizing Statute(s): US Code: 29 USC 3224(a) Name of Law: Title 29 of the American Competitiveness and Workforce Improvement Act
  

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 66308	12/26/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 58073	09/17/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Semi-structured program stakeholder interview protocol
Interview Respondent Info Form
NHE Focus Group Protocol
Participant Focus Group Information Form

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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	160	0	0	160	0	0
Annual Time Burden (Hours)	117	0	0	117	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.

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Annual Cost to Federal Government: $58,105

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? No

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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: 09/17/2020

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