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

Forms and Documents

Document Name	Status
Form Section B: PDO Section B: PDO Form and Instruction	New
Form Section A: Rx Section A: Rx Form and Instruction	New
Form DSP-MRT Standard T DSP-MRT Standard Tool Form and Instruction	Modified
SS_A_DSP_MRT_6_15_17.docx Supporting Statement A	2017-06-15
SS_B_DSP_MRT_6_15_17.docx Supporting Statement B	2017-06-15

IC Document Collections

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

ICR Details

OMB Control No: 0930-0354	ICR Reference No: 201706-0930-002
Status: Historical Active	Previous ICR Reference No: 201512-0930-004
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: 07/17/2017
	Date Received in OIRA: 06/16/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2020	36 Months From Approved	03/31/2019
Responses	728	0	438
Time Burden (Hours)	1,816	0	1,107
Cost Burden (Dollars)	0	0	0

---

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.

---

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

---

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:
	82 FR 17669	04/12/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 27714	06/16/2017
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
DSP-MRT Standard Tool	DSP-MRT Standard Tool	DSP-MRT Standard Tool
Section A: Rx	Section A: Rx	Section A: Rx
Section B: PDO	Section B: PDO	Section B: PDO

---

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	728	438	0	290	0	0
Annual Time Burden (Hours)	1,816	1,107	0	709	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: Currently there are 1,107 burden hours in the OMB inventory. SAMHSA is requesting 1,816 hours. The increase of 709 hours is due to a program change by an addition of respondents and instruments.

---

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

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

---

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: 06/16/2017

---