Advancing Wellness and Resilience in Education and Trauma-Informed Services in Schools

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form School Climate and School Climate and Safety Survey—School Staff	Form and Instruction	New	Repair queued
Form School Climate and School Climate and Safety Survey–Student	Form and Instruction	New	Repair queued
Form School Climate and School Climate and Safety Survey–Parent/Guardian	Form and Instruction	New	Repair queued
Form Student Identifica Student Identification and Referral Form	Form and Instruction	New	Available
Form Student Identifica Student Identification and Referral Form	Form and Instruction	New	Repair queued
Form School Climate and School Climate and Safety Survey	Form and Instruction	New	Repair queued
Form Workforce Follow-U Workforce Follow-Up Survey	Form and Instruction	New	Available
Form Workforce Follow-U Workforce Follow-Up Survey	Form and Instruction	New	Repair queued
Form TISS Training Pre- TISS Training Pre-Post Survey	Form and Instruction	New	Available
Form TISS Training Pre- TISS Training Pre-Post Survey	Form and Instruction	New	Repair queued
Form AWARE Training Pre AWARE Training Pre-Post Survey	Form and Instruction	New	Available
Form AWARE Training Pre AWARE Training Pre-Post Survey	Form and Instruction	New	Repair queued
Form Participant Feedba Participant Feedback Form	Form and Instruction	New	Available
Form Participant Feedba Participant Feedback Form	Form and Instruction	New	Repair queued
Form Training Summary F Training Summary Form	Form and Instruction	New	Available
Form Training Summary F Training Summary Form	Form and Instruction	New	Repair queued
Form Collaboration and Collaboration and Partnership Survey	Form and Instruction	New	Available
Form Collaboration and Collaboration and Partnership Survey	Form and Instruction	New	Repair queued
Form Youth and Family F Youth and Family Focus Group-Parent/Caregiver	Form and Instruction	New	Repair queued
Form Youth and Family F Youth and Family Focus Group- Youth	Form and Instruction	New	Available
Form Youth and Family F Youth and Family Focus Group	Form and Instruction	New	Repair queued
Form Implementation Key Implementation Key Informant Interview-SchoolAdmin	Form and Instruction	New	Available
Form Implementation Key Implementation Key Informant Interview	Form and Instruction	New	Repair queued
Form Attachment A: Impl Attachment A: Implementation Survey	Form and Instruction	New	Available
Form Attachment A: Impl Implementation Survey	Form and Instruction	New	Repair queued
ATT.P_Detailed Description of Project AWARE-TISS Cross-Site Evaluation Components for OMB_Final Clean_09062023.docx	Supplementary Document	Uploaded 2024-04-08	Repair queued
ATT.O_Project AWARE-TISS Cross-Site Evaluation Questions for OMB_Final Clean_09062023.docx	Supplementary Document	Uploaded 2024-04-08	Repair queued
Att.N_ ATODS DUA for OMB_Final Clean_09062023.docx	Supplementary Document	Uploaded 2024-04-08	Repair queued
5. Project AWARE-TISS Cross-Site Evaluation Part B.docx	Supporting Statement B	Uploaded 2024-04-08	Available
4. Project AWARE-TISS Cross-Site Evaluation Part A.docx	Supporting Statement A	Uploaded 2024-04-08	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
268040	School Climate and Safety Surveys	Form and Instruction	New	School Climate and Safety Survey—School Staff
268040	School Climate and Safety Surveys	Form and Instruction	New	School Climate and Safety Survey–Student
268040	School Climate and Safety Surveys	Form and Instruction	New	School Climate and Safety Survey–Parent/Guardian
266683	Student Identification and Referral Form	Form and Instruction	New	Student Identification and Referral Form
266683	Student Identification and Referral Form	Form and Instruction	New
266681	School Climate and Safety Survey	Form and Instruction	New
266679	Workforce Follow-Up Survey	Form and Instruction	New	Workforce Follow-Up Survey
266679	Workforce Follow-Up Survey	Form and Instruction	New
266678	TISS Training Pre-Post Survey	Form and Instruction	New	TISS Training Pre-Post Survey
266678	TISS Training Pre-Post Survey	Form and Instruction	New
266677	AWARE Training Pre-Post Survey	Form and Instruction	New	AWARE Training Pre-Post Survey
266677	AWARE Training Pre-Post Survey	Form and Instruction	New
266676	Participant Feedback Form	Form and Instruction	New	Participant Feedback Form
266676	Participant Feedback Form	Form and Instruction	New
266675	Training Summary Form	Form and Instruction	New	Training Summary Form
266675	Training Summary Form	Form and Instruction	New
266673	Collaboration and Partnership Survey	Form and Instruction	New	Collaboration and Partnership Survey
266673	Collaboration and Partnership Survey	Form and Instruction	New
266672	Youth and Family Focus Group	Form and Instruction	New	Youth and Family Focus Group-Parent/Caregiver
266672	Youth and Family Focus Group	Form and Instruction	New	Youth and Family Focus Group- Youth
266672	Youth and Family Focus Group	Form and Instruction	New
266671	Implementation Key Informant Interview	Form and Instruction	New	Implementation Key Informant Interview-SchoolAdmin
266671	Implementation Key Informant Interview	Form and Instruction	New
266668	Implementation Survey	Form and Instruction	New	Attachment A: Implementation Survey
266668	Implementation Survey	Form and Instruction	New

ICR Details

OMB Control No: 0930-0398	ICR Reference No: 202404-0930-003
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Advancing Wellness and Resilience in Education and Trauma-Informed Services in Schools
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: 05/30/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/11/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2027	36 Months From Approved
Responses	23,814	0	0
Time Burden (Hours)	7,416	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This program is a national cross-site evaluation of process, outcomes, and associated impact for the Advancing Wellness and Resilience in Education (hereinafter referred to as Project AWARE) and Trauma-Informed Services in Schools (TISS) programs. This evaluation reflects SAMHSA’s desire to better understand how each program is implemented, the extent to which they facilitate collaboration between education agencies and mental health systems, and how each program contributes to referral to mental healthcare and improved outcomes for youth.

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Authorizing Statute(s): US Code: 42 USC 520 Name of Law: CMHS
  

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:
	89 FR 1581	01/10/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 18952	03/15/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 11

table that charts list of burden

IC Title	Form No.	Form Name
AWARE Training Pre-Post Survey	AWARE Training Pre-Post Survey	AWARE Training Pre-Post Survey
Collaboration and Partnership Survey	Collaboration and Partnership Survey	Collaboration and Partnership Survey
Implementation Key Informant Interview	Implementation Key Informant Interview-SchoolAdmin	Implementation Key Informant Interview-SchoolAdmin
Implementation Survey	Attachment A: Implementation Survey	Attachment A: Implementation Survey
Participant Feedback Form	Participant Feedback Form	Participant Feedback Form
School Climate and Safety Surveys	School Climate and Safety Survey–Parent/Guardian, School Climate and Safety Survey–Student, School Climate and Safety Survey—School Staff	School Climate and Safety Survey–Parent/Guardian ,   School Climate and Safety Survey–Student ,   School Climate and Safety Survey—School Staff
Student Identification and Referral Form	Student Identification and Referral Form	Student Identification and Referral Form
TISS Training Pre-Post Survey	TISS Training Pre-Post Survey	TISS Training Pre-Post Survey
Training Summary Form	Training Summary Form	Training Summary Form
Workforce Follow-Up Survey	Workforce Follow-Up Survey	Workforce Follow-Up Survey
Youth and Family Focus Group	Youth and Family Focus Group-Parent/Caregiver, Youth and Family Focus Group- Youth	Youth and Family Focus Group- Youth ,   Youth and Family Focus Group-Parent/Caregiver

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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	23,814	0	0	23,814	0	0
Annual Time Burden (Hours)	7,416	0	0	7,416	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 information collection.

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Annual Cost to Federal Government: $2,511,280

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: 04/11/2024

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