SAMHSA Data Security Requirements for Accessing Confidential Data

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SAMHSA RDC Student SAMHSA RDC Student Data User Acknowledgment Form	Form and Instruction	Modified	Available
Form Data Use Agreement Data Use Agreement Form	Form and Instruction	Modified	Available
Form Designated Agent F Designated Agent Form	Form and Instruction	Modified	Available
SAP Data Security Requirements SSA.docx	Supporting Statement A	Uploaded 2026-10-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
261703	SAMHSA Data Security Requirements for Accessing Confidential Data	Form and Instruction	Modified	SAMHSA RDC Student Data User Acknowledgment Form
261703	SAMHSA Data Security Requirements for Accessing Confidential Data	Form and Instruction	Modified	Data Use Agreement Form
261703	SAMHSA Data Security Requirements for Accessing Confidential Data	Form and Instruction	Modified	Designated Agent Form

ICR Details

OMB Control No: 0930-0396	ICR Reference No: 202610-0930-001
Status: Received in OIRA	Previous ICR Reference No: 202308-0930-001
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: SAMHSA Data Security Requirements for Accessing Confidential Data
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/23/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2026
Responses	15	15
Time Burden (Hours)	10	10
Cost Burden (Dollars)	0	0

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Abstract: When an application process starts in the SAP Portal, the SAP system will collect information and SAMHSA will review the application to fulfill its data security requirements. This is a required step before providing the individual with access to confidential microdata for the purpose of evidence building. SAMHSA’s data security agreements and other paperwork, along with the corresponding security protocols, allow SAMHSA to maintain careful controls on confidentiality and privacy, as required by law. This collection will occur outside of the SAP Portal.

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Authorizing Statute(s): US Code: 44 USC 3583 Name of Law: The Foundations for Evidence-Based Policymaking Act of 2018
  

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:
	91 FR 52312	08/13/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 66572	10/21/2026
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
SAMHSA Data Security Requirements for Accessing Confidential Data	Designated Agent Form, Data Use Agreement Form , SAMHSA RDC Student Data User Acknowledgment Form	Designated Agent Form ,   Data Use Agreement Form ,   SAMHSA RDC Student Data User Acknowledgment Form

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	15	15	0	0	0	0
Annual Time Burden (Hours)	10	10	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: $150,000

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.     Yes

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.     Yes

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: 10/23/2026

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