SUD Placement Criteria Survey

Forms and Documents

Document Name	Status
4. Attachment B - Introductory Cover Letter 7-23-2020 CLEAN.docx Supplementary Document	2020-08-07
1. 0990-SS_A Patient Placement May12020 revised 7 24 clean.docx Supporting Statement A	2020-08-07
60-Day FRN 0990- Patient Placement Survey - 2 7 20.docx Supplementary Document	2020-02-07
4. Attachment B - Introductory Cover Letter 1-9-2020.docx Supplementary Document	2020-02-04
2. SUD placement criteria survey OMB_Part B 1-14-2020 lljk edits.docx Supporting Statement B	2020-02-04

IC Document Collections

IC ID	Document Title	Status
241655	Survey Other-survey	New

ICR Details

OMB Control No: 0990-0474	ICR Reference No: 202002-0990-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: SUD Placement Criteria Survey
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: 08/07/2020
	Date Received in OIRA: 05/01/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2021	12 Months From Approved
Responses	87	0	0
Time Burden (Hours)	15	0	0
Cost Burden (Dollars)	793	0	0

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Abstract: The Assistant Secretary for Planning and Evaluation (ASPE) is requesting clearance for a one-time survey of state agencies regarding the use of substance use disorder (SUD) patient placement criteria and assessment tools. This survey is one component of a larger project to assess the feasibility of gathering and utilizing needs assessment data to identify and address unmet patient needs by levels of care. Respondents will be two state officials in each of the 50 states and the District of Columbia and will take approximately 10 minutes to complete.

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Authorizing Statute(s): None

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:
	85 FR 8305	02/13/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 23835	04/29/2020
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Survey

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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	87	0	0	87	0	0
Annual Time Burden (Hours)	15	0	0	15	0	0
Annual Cost Burden (Dollars)	793	0	0	793	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: New Collection

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Annual Cost to Federal Government: $52,592

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? 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: 05/01/2020

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