Division of State Programs—Management Reporting Tool (DSP-MRT)

Forms and Documents

Document Name	Status
Form PFS Section C: PFS Outcomes Form and Instruction	New
Form Section B: PDO Section B: PDO Form and Instruction	Modified
Form Section A: Rx Section A: Rx Form and Instruction	Modified
Form Standard Tool DSP-MRT Standard Tool Form and Instruction	Modified
DSP_MRT_SS_B_DSP_MRT 7.24.18.docx Supporting Statement B	2018-07-24
DSP_MRT_SS_A_DSP_MRT 7.24.18.docx Supporting Statement A	2018-07-24

IC Document Collections

IC ID	Document Title	Status
232354	Section C: PFS Outcomes Form and Instruction	New
227196	Section B: PDO Form and Instruction	Modified
227195	Section A: Rx Form and Instruction	Modified
219387	DSP-MRT Standard Tool Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0354	ICR Reference No: 201807-0930-001
Status: Active	Previous ICR Reference No: 201706-0930-002
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Division of State Programs—Management Reporting Tool (DSP-MRT)
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: 11/15/2018
	Date Received in OIRA: 07/25/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2021	36 Months From Approved	07/31/2020
Responses	708	0	728
Time Burden (Hours)	1,786	0	1,816
Cost Burden (Dollars)	0	0	0

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Abstract: The Division of State Program -Monitoring and Reporting Tool will air to address underage drinking (UAD; age 12 to 20) and prescription drug misuse and abuse (PDM; age 12 to 25) . This data collection will allow all DSP programs to report into a standard tool that aligns with the Strategic Prevention Framework model. This request for data collection includes a revision from a previously approved OMB instrument formally known as Partnerships for Success-Management and Reporting Tool.

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Authorizing Statute(s): US Code: 42 USC 516 Name of Law: Priority SAP Needs of Regional and National Significance
  

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:
	83 FR 23475	05/21/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 34855	07/23/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
DSP-MRT Standard Tool	Standard Tool	Standard Tool
Section A: Rx	Section A: Rx	Section A: Rx
Section B: PDO	Section B: PDO	Section B: PDO
Section C: PFS Outcomes	PFS	PFS

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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	708	728	0	-20	0	0
Annual Time Burden (Hours)	1,786	1,816	0	-30	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 1,816 burden hours in the OMB inventory. The program is requesting 1,786 hours, a decrease of 30 hours. Even though Section C added 213 burden hours, the decrease in the number of respondents reduced the overall burden for the standard tool.

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Annual Cost to Federal Government: $1,028,717

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

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.     No

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.     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: 07/25/2018

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