Technology Transfer Center (TTC) Program Monitoring

Forms and Documents

Document Name	Status
Form Follow-up Form - I Follow-up Forms Form and Instruction	New
Form Post Event Form - Post Event Forms Form and Instruction	New
Form Event Description Event Description Form Form and Instruction	New
Attachment 10_TTC Statement of Informed Consent_5.2.2019.doc Supplementary Document	2019-05-06
Attachment 9_TTC Contact Information Form_5_2_2019.doc Supplementary Document	2019-05-06
Attachment 7_ TTC Cover page for instruments_5_2_2019.doc Supplementary Document	2019-05-06
Attachment 10_TTC Statement of Informed Consent.doc Supplementary Document	2018-12-18
TCC_OMB SS-B_12.18.18.doc Supporting Statement B	2018-12-18
Attachment 9_TTC Contact Information Form.doc Supplementary Document	2018-12-18
Attachment 8_TTC Model Statement.doc Supplementary Document	2018-12-18
Attachment 7_ TTC Cover page for instruments.doc Supplementary Document	2018-12-18
TCC_OMB SS-A_5_6_19.doc Supporting Statement A	2019-05-06
Attachment 6_TTC Sample Cover Letters.doc Supplementary Document	2018-12-18

IC Document Collections

IC ID	Document Title	Status
234553	Follow-up Forms Form and Instruction	New
234552	Post Event Forms Form and Instruction	New
234551	Event Description Form Form and Instruction	New

ICR Details

OMB Control No: 0930-0383	ICR Reference No: 201812-0930-002
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Technology Transfer Center (TTC) Program Monitoring
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: 05/08/2019
	Date Received in OIRA: 12/21/2018
Terms of Clearance: Clearance is provided consistent with the understanding that if SAMHSA seeks to extend this form, it will include an analysis of the feasibility of generating unique identifiers that do not include any digits of Social Security Numbers or similar National Identification Numbers.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2022	36 Months From Approved
Responses	128,250	0	0
Time Burden (Hours)	19,988	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Technology Transfer Centers are part of SAMHSA’s restructuring of technical assistance and training. SAMHSA is building a national system of resources that will be available at no cost, or at most low cost (e.g., payment for continuing education credits, small fees for training taking place at venues that must be rented), to any individual or program wishing to take advantage of them. Building off the success of the ATTCs, SAMHSA is establishing new TTCs in prevention of substance use disorders and serious mental illness.

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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:
	83 FR 51970	10/15/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 65698	12/21/2018
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Event Description Form	Event Description Form	Event Description Form
Post Event Forms	Post Event Form - International, Post Event Form - Domestic	Post Event Form - Domestic ,   Post Event Form - International
Follow-up Forms	Follow-up Form - International, Follow-up Form - Domestic	Follow-up Form - International ,   Follow-up Form - Domestic

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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	128,250	0	0	128,250	0	0
Annual Time Burden (Hours)	19,988	0	0	19,988	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: $78,234

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: 12/21/2018

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