Quarterly Progress Reporting and Annual Indirect Services Outcome Data Collection for the Minority Substance Abuse/HIV Prevention Program (MAI)

Forms and Documents

Document Name	Status
Form HIV Testing Retros HIV Testing Retrospective Reporting Tool Form and Instruction	New
Form Indirect Services Indirect Services Outcomes Form and Instruction	New
Form Quarterly Progress Quarterly Progress Report Form and Instruction	New
MAI_MRT_ SS_A_1_27_16.docx Supporting Statement A	2016-01-27
MAI_MRT_SS_B 10.28.15.docx Supporting Statement B	2016-01-27

IC Document Collections

IC ID	Document Title	Status
219826	HIV Testing Retrospective Reporting Tool Form and Instruction	New
219825	Indirect Services Outcomes Form and Instruction	New
219824	Quarterly Progress Report Form and Instruction	New

ICR Details

OMB Control No: 0930-0357	ICR Reference No: 201601-0930-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Quarterly Progress Reporting and Annual Indirect Services Outcome Data Collection for the Minority Substance Abuse/HIV Prevention Program (MAI)
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 without change	Conclusion Date: 05/02/2016
	Date Received in OIRA: 01/29/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2019	36 Months From Approved
Responses	806	0	0
Time Burden (Hours)	2,848	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The MAI grantees that will use these instruments are community-based organizations (CBOs) and minority serving educational institutions (MSIs) that serve high-risk minority populations with the goal of preventing substance abuse and HIV & viral hepatitis (VH) transmission through integrated prevention services and referrals to treatment as needed. The Quarterly Progress Report is intended to standardize and facilitate quarterly progress reporting required from all grantees as part of their grant agreements. By providing a standard online instrument for collecting information on grantees’ quarterly activities, accomplishments, and challenges, SAMHSA aims to reduce the burden of this quarterly reporting requirement on the grantees, assist the government project officers (PO) in monitoring the grantees’ performance, and help identify any technical assistance needs in a timely fashion.

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Authorizing Statute(s): US Code: 5 USC 1105(a)(29) Name of Law: GPRA
  

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:
	80 FR 69234	11/09/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 4325	01/26/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Quarterly Progress Report	Quarterly Progress Report	Quarterly Progress Report
Indirect Services Outcomes	Indirect Services Outcomes	Indirect Services Outcomes
HIV Testing Retrospective Reporting Tool	HIV Testing Retrospective Reporting Tool	HIV Testing Retrospective Reporting Tool

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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	806	0	0	806	0	0
Annual Time Burden (Hours)	2,848	0	0	2,848	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 data collection.

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Annual Cost to Federal Government: $311,202

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: 01/29/2016

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