SAMHSA Fetal Alcohol Spectrum Disorders Center for Excellence Screening and Brief Intervention Project and Project CHOICES Evaluation

Forms and Documents

Document Name	Status
Form FormB_SBI_Process FASD - CFE - SBI - CHOICES Form and Instruction	Modified
OMB_SS-B 9.24.13.docx Supporting Statement B	2013-09-24
OMB_SS-A 9.24.13.docx Supporting Statement A	2013-09-24

IC Document Collections

IC ID	Document Title	Status
189113	FASD - CFE - SBI - CHOICES Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0302	ICR Reference No: 201310-0930-001
Status: Historical Inactive	Previous ICR Reference No: 200905-0930-001
Agency/Subagency: HHS/SAMHSA	Agency Tracking No: 20598
Title: SAMHSA Fetal Alcohol Spectrum Disorders Center for Excellence Screening and Brief Intervention Project and Project CHOICES Evaluation
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 03/24/2014
	Date Received in OIRA: 10/22/2013
Terms of Clearance: SAMHSA has withdrawn this collection due to funding issues.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the FASD Center for Excellence is to promote the prevention of FASD and address the needs of individuals and families affected by FASD by providing technical assistance and training, a range of services, information, and support to communities to prevent alcohol-exposed pregnancies. Data will be collected from women served across approximately ten sites in local/community-based agencies. Women will be screened for alcohol use and provided with appropriate program based on their status as either pre-conception (non-pregnant) or pregnant.

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Authorizing Statute(s): US Code: 42 USC 505 Name of Law: Data Collection
  

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:
	78 FR 44956	07/25/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 58326	09/23/2013
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
FASD - CFE - SBI - CHOICES	FormB_SBI_Process, FormA_Assessment_Tool, FormC_Client_Satisfaction	FormB_SBI_Process ,   FormA_Assessment_Tool ,   FormC_Client_Satisfaction

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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 reinstatement/new data collection.

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Annual Cost to Federal Government: $156,475

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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? Uncollected

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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: 10/22/2013

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