Disaster Technical Assistance Center Disaster Mental Health Needs Assessment and Customer Satisfaction Survey

Forms and Documents

Document Name	Status
Form SAMHSA DTAC CFS e-Communications Recipient Form and Instruction	Modified
Form State-Territory DBHNAS (State/Territory) Form and Instruction	Removed
Form Local Provider DBHNAS (Local Provider) Form and Instruction	Removed
Form Follow-Up Phone In DBHNA Follow-up Form and Instruction	Removed
0325 DTAC CFS OMB Justification A 101816.docx Supporting Statement A	2016-10-18
0325 DTAC CFS OMB Justification B 062716.docx Supporting Statement B	2016-10-18

IC Document Collections

IC ID	Document Title	Status
197113	e-Communications Recipient Form and Instruction	Modified
197112	DBHNAS (State/Territory) Form and Instruction	Removed
197111	DBHNAS (Local Provider) Form and Instruction	Removed
197110	DBHNA Follow-up Form and Instruction	Removed

ICR Details

OMB Control No: 0930-0325	ICR Reference No: 201610-0930-003
Status: Historical Active	Previous ICR Reference No: 201403-0930-006
Agency/Subagency: HHS/SAMHSA	Agency Tracking No: 21581
Title: Disaster Technical Assistance Center Disaster Mental Health Needs Assessment and Customer Satisfaction Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/23/2017
	Date Received in OIRA: 10/19/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2020	36 Months From Approved	05/31/2017
Responses	200	0	577
Time Burden (Hours)	100	0	227
Cost Burden (Dollars)	0	0	0

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Abstract: The National Response Framework (NRF), establishes the framework for a comprehensive, national, "all-hazards" approach to domestic incident response. The NRF outlines how communities, States, the Federal Government, and private-sector and nongovernmental partners will work together in a coordinated fashion to plan for and develop comprehensive response plans for all types of emergency events. This data collection efforts will provide feedback on the overall effectiveness of SAMHSA Disaster Technical Assistance Center's (DTAC) services, ongoing needs at the national level, and areas that require enhanced Technical Assistance (TA) services.

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Authorizing Statute(s): US Code: 42 USC 501 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:
	81 FR 53494	08/12/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 72068	10/19/2016
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
DBHNAS (Local Provider)	Local Provider	Local Provider
e-Communications Recipient	SAMHSA DTAC CFS	SAMHSA DTAC CFS
DBHNA Follow-up	Follow-Up Phone Interview Guide	Follow-Up Phone Interview Guide
DBHNAS (State/Territory)	State-Territory	State-Territory

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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	200	577	0	-377	0	0
Annual Time Burden (Hours)	100	227	0	-127	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Currently, there are 227 respondent burden hours in the OMB inventory. SAMHSA is requesting 100 hours. This program change represents a 127-hour decrease in total burden due to revisions in instruments.

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Annual Cost to Federal Government: $160,000

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: 10/19/2016

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