SAMHSA Disaster Technical Assistance Center Training, Webinar, Podcast, and Mobile Application Feedback Forms

Forms and Documents

Document Name	Status
Form Webinar Follow-Up Webinar Feedback Form Follow-up Interviews Form and Instruction	New
Form Training Follow-Up Training Feedback Form Follow-up Interviews Form and Instruction	New
Form Mobile App Form Mobile Application Survey Form and Instruction	New
Form Webinar Podcast Fo Webinar Podcast Feedback Form Form and Instruction	New
Form Training Form Training Feedback Form Form and Instruction	New
DTAC Event OMB SS-B 1-8-2014.docx Supporting Statement B	2014-01-08
DTAC Event OMB SS-A 1-8-2014.docx Supporting Statement A	2014-01-08

IC Document Collections

IC ID	Document Title	Status
209523	Webinar Feedback Form Follow-up Interviews Form and Instruction	New
209522	Training Feedback Form Follow-up Interviews Form and Instruction	New
209521	Mobile Application Survey Form and Instruction	New
209520	Webinar Podcast Feedback Form Form and Instruction	New
209519	Training Feedback Form Form and Instruction	New

ICR Details

OMB Control No: 0930-0338	ICR Reference No: 201311-0930-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No: 20952
Title: SAMHSA Disaster Technical Assistance Center Training, Webinar, Podcast, and Mobile Application Feedback Forms
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: 01/08/2014
	Date Received in OIRA: 11/27/2013
Terms of Clearance: SAMHSA shall accurately account for the costs to the Federal government.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2017	36 Months From Approved
Responses	5,145	0	0
Time Burden (Hours)	1,373	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: SAMHSA DTAC provides training, webinars, and podcasts in response to, and in preparation for, behavioral health (mental health and substance abuse) needs associated with catastrophic events and emergencies, such as natural disasters, human caused disasters, and technological disasters. These trainings, webinars, and podcasts (TWPs) cover various topics of interest to the disaster behavioral health fields, such as responding to specific types of disasters, working with specific groups of the population to prepare for or respond to disasters, and general disaster behavioral health challenges.

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Authorizing Statute(s): None

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 54261	09/03/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 67376	11/12/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Training Feedback Form Follow-up Interviews	Training Follow-Up Interview	Training Follow-Up Interview
Webinar Feedback Form Follow-up Interviews	Webinar Follow-Up Interview	Webinar Follow-Up Interview
Mobile Application Survey	Mobile App Form	Mobile App Form
Training Feedback Form	Training Form	Training Form
Webinar Podcast Feedback Form	Webinar Podcast Form	Webinar Podcast Form

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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	5,145	0	0	5,145	0	0
Annual Time Burden (Hours)	1,373	0	0	1,373	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: $70,000

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: 11/27/2013

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