OMB control number

State Targeted Response to the Opioid Crisis (Opioid STR) Evaluation

OMB 0930-0379 · HHS/SAMHSA.

OMB 0930-0379

SAMHSA recently awarded 57 grants to states and territories to help address the national opioid crisis by increasing access to treatment, reducing unmet treatment needs, and reducing opioid overdose related deaths through the provision of prevention, treatment, and recovery activities for opioid use disorder (OUD). SAMHSA will be conducting a cross-site evaluation of the Opioid STR grant program. The proposed data collection is necessary to evaluate how the Opioid STR state/territory grantees plan and implement prevention, treatment and recovery services. Additionally, a subset of communities/programs will be selected to participate in supplemental evaluation activities designed to provide detailed information related to the implementation of services at the program/community level, as well as the impacts of the program on client outcomes.

The latest form for State Targeted Response to the Opioid Crisis (Opioid STR) Evaluation expires 2020-09-30 and is listed under ICR 201707-0930-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form GPRA Client Outcom Client-level Data for Community Program Level - Discharge	Form and Instruction
Form GPRA Client Outcom Client-level Data for Community Program Level - Follow-up	Form and Instruction
Form GPRA Client Outcom Client-level Data for Community Program Level - Baseline	Form and Instruction
Form Community-Program Community Program Director - Time 3	Form and Instruction
Form Community-Program Community Program Director - Time 2	Form and Instruction
Form Community-Program Community Program Director - Baseline	Form and Instruction
Form Community-Program Community Program Data Manager - Time 2	Form and Instruction
Form Community-Program Community Program Clinical Staff - Time 2	Form and Instruction
Form Community-Program Community Program Clinical Staff - Time 2	Form and Instruction
Form Community-Program Community Program Data Manager - Baseline	Form and Instruction
Form Community-Program Community Program Clinical Staff - Baseline	Form and Instruction
Form Community-Program Community Program Director - Baseline	Form and Instruction
Form State Director Tim State Interview protocol - Time 2	Form and Instruction
Form State Director Tim State Interview Protocol - Time 1	Form and Instruction
Form State Director Tim State Survey - Time 3	Form and Instruction
Form State Director Tim State Survey - Time 2	Form and Instruction
Form State Director Bas State Survey - Baseline	Form and Instruction
Opioid STR OMB SS-B 7.6.17.docx	Supporting Statement B
Opioid STR OMB SS-A 7.6.17.docx	Supporting Statement A
Client-level Data for Community Program Level - Discharge	Form and Instruction
Client-level Data for Community Program Level - Follow-up	Form and Instruction
Client-level Data for Community Program Level - Baseline	Form and Instruction
Community Program Director - Time 3	Form and Instruction
Community Program Director - Time 2	Form and Instruction
Community Program Director - Baseline	Form and Instruction
Community Program Data Manager - Time 2	Form and Instruction
Community Program Clinical Staff - Time 2	Form and Instruction
Community Program Clinical Staff - Time 2	Form and Instruction
Community Program Data Manager - Baseline	Form and Instruction
Community Program Clinical Staff - Baseline	Form and Instruction
Community Program Director - Baseline	Form and Instruction
State Interview protocol - Time 2	Form and Instruction
State Interview Protocol - Time 1	Form and Instruction
State Survey - Time 3	Form and Instruction
State Survey - Time 2	Form and Instruction
State Survey - Baseline	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
201707-0930-001	New collection (Request for a new OMB Control Number)	2017-07-06		Approved without change

OMB Details

State Survey - Baseline

Federal Enterprise Architecture: Health - Public Health Monitoring

Information collection instruments
Form	Name	Electronic access	Type
Form State Director Baseline Survey	State Director Baseline Survey	Fillable Fileable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.