RECOVERY: Increasing Adoption of Patient Centered Behavioral Health Research by Primary and Behavioral Health Providers and Systems

Forms and Documents

Document Name	Status
Form Attachment D_Follo Practitioners Form and Instruction	New
Form Attachment G_Evalu Admininstrators Form and Instruction	New
Form Attachment C_Follo Directors Form and Instruction	New
OMB_CER_Supporting Statement_B_5.2.11.doc Supporting Statement B	2011-05-02
Attachment J_IRB Letter of Approval.pdf Supplementary Document	2011-05-03
Attachment I_Email Correspondence to Participants_Final.doc Supplementary Document	2011-05-03
Attachment H_Copy of Survey Screen.docx Supplementary Document	2011-05-03
OMB_CER_Supporting Statement_A_5.2.11.doc Supporting Statement A	2011-05-02

IC Document Collections

IC ID	Document Title	Status
197695	Practitioners Form and Instruction	New
197694	Admininstrators Form and Instruction	New
197693	Directors Form and Instruction	New

ICR Details

OMB Control No: 0930-0327	ICR Reference No: 201105-0930-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: RECOVERY: Increasing Adoption of Patient Centered Behavioral Health Research by Primary and Behavioral Health Providers and Systems
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 with change	Conclusion Date: 08/10/2011
	Date Received in OIRA: 05/13/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2014	36 Months From Approved
Responses	2,500	0	0
Time Burden (Hours)	920	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: SAMHSA will be collecting data from healthcare directors, administrators, practitioners, on dissemination strategies and mechanisms for promoting implementation of CER results by intended audiences (e.g., hospitals, healthcare systems managed care organizations, State and community-based providers). The collected data will also allow for an examination of contextual factors, both organizational and individual, that influence the decisions to adopt a new evidence-based treatment approach.

---

Authorizing Statute(s): PL: Pub.L. 111 - 5 0 Name of Law: ARRA
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 9033	02/16/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 24500	05/02/2011
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Directors	Attachment C_Followup Survey Director, Attachment A_Baseline Survey Director, Attachment G_Evaluation Survey_Coaching Webinar_Fi, Attachment E_Evaluation Survey_Packets_Final_with , Attachment F_Evaluation Survey_Training Webinar_Fi	Attachment C_Followup Survey Director ,   Attachment E_Evaluation Survey_Packets_Final_with OMB changes ,   Attachment F_Evaluation Survey_Training Webinar_Final_with OMB changes ,   Attachment G_Evaluation Survey_Coaching Webinar_Final_with OMB changes ,   Attachment A_Baseline Survey Director
Admininstrators	Attachment B_ Baseline Survey Staff, Attachment D_Followup Survey Staff, Attachment E_Evaluation, Attachment G_Evaluation, Attachment F_Evaluation	Attachment G_Evaluation ,   Attachment F_Evaluation ,   Attachment E_Evaluation ,   Attachment B_ Baseline Survey Staff ,   Attachment D_Followup Survey Staff
Practitioners	Attachment F_Evaluation , Attachment G_Evaluation , Attachment D_Followup Survey Staff, Attachment B_ Baseline Survey Staff, Attachment E_Evaluation	Attachment D_Followup Survey Staff ,   Attachment B_ Baseline Survey Staff ,   Attachment E_Evaluation ,   Attachment F_Evaluation ,   Attachment G_Evaluation

---

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	2,500	0	0	2,500	0	0
Annual Time Burden (Hours)	920	0	0	920	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.

---

Annual Cost to Federal Government: $613,201

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)? Yes

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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: 05/13/2011

---