Form Substitue Data Req Substitue Data Req Substitue Data Request Form

Program Evaluation
for Prevention:
SPF-Rx
Substitute Data Source Request
This instrument is not OMB approved and is provided for informational purposes only while
the instrument is under OMB review. The final items are subject to change as part of the
OMB approval process.

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Page Title: Substitute Data Source Request

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Outcome Data > Substitute Data Source Request Submission

Substitute Data Source Request
1 Select Grantee:

Use this section to obtain approval from your State Project Officer for the use of substitute outcome measures
in place of SPF-Rx Required Outcome Measures.
Note that you need to submit a substitute data request only for measures you are using to meet the annual
outcome measure requirements for opioid overdoses and deaths, Prescription Drug Monitoring Program
indicators, and survey indicators of prescription drug misuse.
You do not need to submit a substitute data request for any other additional, non-required measures you plan
to submit.
To begin the substitute measure approval process:
First, decide whether your proposed substitute is likely to be approved. Click here to view the SPF-Rx
Community Outcomes Guidance Manual. Table x of the manual shows the SPF-Rx Required Outcome Measures
and Table x shows a comparison between SPF-Rx Required Outcome Measure survey items and items from
commonly used surveys.
Note: If an item is listed in the Guidance Manual as an acceptable (or unacceptable) SPF-Rx Required Outcome
Measure substitute, then you will not need to submit a substitute data request for the measure.

2

Add a Substitute Data Source Request

Page Details
1. Only SPO and higher roles will see this field.
SPOs will see only their grantees. Higher roles
will see all grantees. Grantee-level roles will not
see the label or dropdown menu.
2. Clicking on “Add a Substitute Data Source
Request” will direct the user to the Add a
Substitute Data Source Request Detail page
(3.4.1), where a record can be added/edited
and submitted for review by the Project Officer
or viewed in read-only mode.
Note: If the status is Submitted, Under Review,
Approved, or Not Approved, the record will be readonly. If the status is Not Submitted or Requires
Revision, it can be edited.

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Page Title: Substitute Data Source Request

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Outcome Data > Substitute Data Source Request Submission
Outcome Measure
Measure

1

4

Submitter Name

2

Name

Date Submitted

Status

mm/dd/yyyy

Click on Grantee-level information or each Subrecipient community below to complete additional questions
related to grantee or subrecipient data. Once you have completed the questions for the grantee or for each
subrecipient, you will be able to click the Submit button to submit your request. You may also click on the
Supporting Documents link if you wish to submit documents related to your request.

Subrecipient(s)

Status

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Name

mm/dd/yyyy

Supporting Documents

7 Grantee-level information (grantee: DEMO SPF-Rx DEPT OF HEALTH (Armed Forces Americas), status:
Submit

3. The “Status” will display the status of the record,
which could include Not Submitted, Submitted,
Under Review, Requires Revision, Approved, or
Not Approved.

6. Clicking the “Submit” button will send an email to
the SPOs, CSAP Management, and the PEP-C
team notifying the submission of the substitute
data source request.

Click on Grantee-level information or each Subrecipient community below to complete additional questions
related to grantee or subrecipient data. Once you have completed the questions for the grantee or for each
subrecipient, you will be able to click the Submit button to submit your request. You may also click on the
Supporting Documents link if you wish to submit documents related to your request.

Incomplete)

2. The “Submitter Name” will display the
“Submitter Name” of the saved record.

5. Clicking the “Supporting Documents” link will
direct user to the Substitute Data Source
Request Supporting Documents page (x.x.x).

Submit

Measure

1. The “Outcome Measure” list will display the
“Substitute Measure Name (Label of the
Substitute Measure)” of the saved record.

4. Clicking on a “Measure” name will direct user to
the Substitute Data Source Request Detail page
(x.x.x).

5 Supporting Documents

6

3

Page Details

7. Clicking the “Grantee-level information XXX”
link will direct user to Substitute Data Source
Request Subrecipient Detail page (x.x.x).

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Page Title: Substitute Data Source Request Detail

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Outcome Data > Substitute Data Source Request Submission > Substitute Data Source Request Detail

Substitute Data Source Request Detail
General Data Source Information
OPTIONAL: Copy data from another record

You can copy the data from an existing, submitted Substitute Data Source Request (SDS) by selecting an existing SDS
and clicking the Copy and Insert into this record button.

Include Grantee/Subrecipient Information
Copy and Insert into this record

Submitter Name:*

1 Submitter Role:*

2 Other Role (Specify):* : (If Other is selected)

3 Submitter Email:*

4

Label of the SPF-Rx Required Outcome Measure(s) indicator for which you are requesting a substituted proxy
measure (e.g., 30-Day Nonmedical Use of Prescription Drugs):*

Data Source Name:*

(maximum 100 chars)

Page Details
1. The “Submitter Role” dropdown contains the
values “Project Director,” “Grantee Evaluator,”
and “Other.”
2. If “Other” is selected in the “Submitter Role”
field, then the “Other Role (Specify)” field is
displayed.
3. The field will accept only properly formatted
email addresses.
4. The “Label of the SPF-Rx Required Outcome
Measure(s) Indicator”… dropdown contains the
values “Emergency department visits or
hospitalizations involving opioid overdose,”
“Opioid overdose deaths,” “PDMP indicators,”
“30-day nonmedical use of prescription drugs,”
“30-day nonmedical use of prescription pain
relievers,” “Past year nonmedical use of
prescription drugs,” “Past year nonmedical use
of prescription pain relievers,” and “Other.”

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Page Title: Substitute Data Source Request Detail

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Outcome Data > Substitute Data Source Request Submission > Substitute Data Source Request Detail
5

6

Page Details

For administrative data, describe/define the proxy item. For survey data, provide the exact wording of the proxy
item and response options the grantee is requesting to substitute for the SPF-Rx Required Outcome Measure:*

5. The “Exact wording of the proxy…” will be a free
text field. For example, grantees could report,
“In the past 12 months, did you use any
prescription pain relievers in a way that a doctor
did not direct you to use them?” Response
options: Yes / No.

(maximum 1000 chars)

6. The “Exact wording of the outcome…” will be a
free text field. For example, grantees could
report, “Percentage who reported any
nonmedical use of prescription drugs during the
past 30 days.”

Exact wording of the outcome that will be reported to SAMHSA/CSAP:*

7. The “Formulae for calculating…” will be a free
text field. For example, grantees could report,
“Recode any response indicating use on at least
one occasion as having used during the past 30
days.”
8. The “Provide a summary…” question will have a
free text field for the response option.
(maximum 3000 chars)

7

Formulae for calculating the outcome measure or deriving the prevalence estimate (reported outcomes):

8

Summarize how the collection and reporting of community-level SPF-Rx Required Outcome Measure was written
in your approved SPF-Rx Strategic Plan:

(maximum 3000 chars)

9

Does the requested substitution differ from what was written in your approved SPF-Rx Strategic Plan?

9. The “Does the requested substitution…” will
contain the two values Yes and No. “No” is the
default.

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Page Title: Substitute Data Source Request Detail

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Outcome Data > Substitute Data Source Request Submission > Substitute Data Source Request Detail
10 If yes, why?* (If Yes is selected)

Page Details
10. If “Yes” is chosen for “Does the request
substitution differ...strategic plan?”, then the
question “If yes, why?” and the free text field will
appear.
11. The “Reason for the substitution request” will be
a free text field. Justification should include
evidence that new data collection or the
modification of an existing data collection effort
necessary for reporting an approved NOM was
investigated and deemed unviable.

(maximum 3000 chars)

11

Reason for the substitution request:*

(maximum 3000 chars)

12

Agency/Organization responsible for data collection:*

(maximum 1000 chars)

13

Who is substitute request for?*

Subrecipient(s):* (If “Subrecipient(s)” is chosen)
14 Data source type:*

12. The “Agency/Organization responsible for data
collection” will be a free text field.
13. The “Who is substitute request for?” dropdown
will contain the values “Grantee” and
“Subrecipients.” If “Subrecipients” is selected, a
checklist of their subrecipients will appear and
the grantee will select the relevant
subrecipients. The first option on the checklist
will allow the grantees to “Select all.”
14. The dropdown for “Data Source Type” will
contain “PDMP Data,” “Other Administrative
Data,” and “Survey Data.” If “Survey Data” is
chosen, additional items will appear.

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Page ID: x.x.x (continued)
Page Title: Substitute Data Source Request Detail

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Outcome Data > Substitute Data Source Request Submission > Substitute Data Source Request Detail

Survey Data Source Information (from the most recent implementation of the survey) If “Survey Data”
is chosen
15

Were there validity and reliability tests of the survey items constituting the substitute measure?*

Were validity and reliability tests conducted for the relevant survey items, either in previous studies/evaluations or for the purpose of
SPF-Rx?

16 Description of the reliability/validity studies:* (If “Yes” is chosen)

(maximum 1000 chars)

17

Are there any published validity or reliability studies for this instrument?*

Were validity and reliability tests conducted for the survey instrument as a whole, either in previous studies/evaluations or for the
purpose of SPF-Rx?

18 Bibliographic Information:* (If “Yes” is chosen)

19 Project Officer Feedback
Status:
Not Submitted

Save

16. If “Yes” is selected in the “Were there validity
and reliability test of the survey items
constituting the substitute measure?” field, then
the “Description of the reliability/validity studies”
appears.
17. The “Are there any published validity or
reliability studies for this instrument?” field will
contain the two values Yes and No. “No” is the
default.
18. If “Yes” is selected in the “Are there any
published validity/reliability studies for this
instrument?” field, then the “Bibliographic
Information” appears.
19. The “Project Officer Feedback” section will
display any feedback provided by the project
officer. The fields Status and Feedback will
appear under the Project Officer Feedback
section and will be populated from the data
entered in the Substitute Data Source Request
Approval section (x.x) by the Project Officer for
this record.
20. Once the status is approved, then the grantee
is assured that the substitute data source can
be reported on in the “SPF-Rx Selected
Outcome Measures” module.

22. Clicking the “Cancel” button will not save any
changes and will return the user to Substitute
Data Source Request listing page (x.x).

Feedback:
21

15. The “Were there validity and reliability tests …”
field will contain the two values Yes and No.
“No” is the default.

21. Clicking the “Save” button will save the record
and return the user to the Substitute Data
Source Request listing page (x.x). If not all
fields required to save are completed or invalid
data is entered, the user will be prevented from
saving and a message will list the fields and
related issues.

(maximum 2000 chars)

20

Page Details

22 Cancel

23 Delete

23. Clicking the “Delete” button will delete the
record and return the user to the Substitute
Data Source Request listing page (x.x).

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Outcome Data > Substitute Data Source Request Submission > Substitute Data Source Request Subrecipient Detail

Substitute Data Source Request Recipient Detail
General Data Source Information
OPTIONAL: Copy data from another record

You can copy the data from an existing, submitted Substitute Data Source Request (SDS) by selecting an existing SDS
and clicking the Copy and Insert into this record button.

Include Grantee/Subrecipient Information
Copy and Insert into this record
1

Do the data approximate the community (e.g., county, city, town, school) where SPF-Rx interventions are
delivered?

Please report whether the boundaries within which data collection occurred approximately match the SPF-Rx community target
area. For example, if the SPF-Rx community is a town within a larger county and the data are county-level data, select "No."

2

If no, indicate how they differ: (If “No” is chosen)

(maximum 3000 chars)

Most recent month and year for which data are available? *

3

Is there a data point collected at least 6 months before the implementation of SPF-Rx interventions in the
community? (i.e., a baseline prevalence estimate):*

Page ID: x.x.x
Page Title: Substitute Data Source Request
Subrecipient Detail
Page Details
1. The “Do the data approximate the community
…” field will contain the two values Yes and No.
“No” is the default.
2. If “No” is selected from “Does the data
approximate… where interventions are
delivered?”, then the question “If no, indicate
how they differ” and the free text field should
appear.
3. The “Is there a data point collected at least 6
month …” field will contain the two values Yes
and No. “No” is the default.

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Outcome Data > Substitute Data Source Request Submission > Substitute Data Source Request Subrecipient Detail

Page ID: x.x.x (continued)
Page Title: Substitute Data Source Request
Subrecipient Detail
Page Details

4 Is the data collection repeated every year?*

4. The “Is the data collection repeated every
year?” field will contain the two values Yes and
No. “No” is the default.

5 Frequency of data collection:* (If “No” is selected)

5. If “No” is selected in the “Is the data collection
repeated every year?” field, then the
“Frequency of data collection” field is displayed.
This is a free-text field.
6. The “Are trend data available?” field will contain
the two values Yes and No. “No” is the default.

6 Are trend data available?*

Please select "Yes" if data are available for two or more time points before the baseline data point.

Start year of trend data:* (If “Yes” is selected)

Date of data collection:*

Sample size:*

Sampling ratio:*

7 What type of sampling strategy was used to select respondents?*

8 Please complete the following information as applicable to the sample. (If Random sample or Stratified random
sample is selected)
Stratified sampling - identify each stratum: (If Random sample or Stratified random sample is selected)

(maximum 1000 chars)

7. The “What type of sampling strategy was used
to select respondents” dropdown includes the
values “Census,” “Convenience sample,”
“Random sample,” and “Stratified random
sample”.
8. If “Random sample” or “Stratified random
sample” is selected in the “What type of
Sampling Strategy was used to select
respondents?” field, then “Please complete the
following information as applicable to the
sample” is displayed.

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Outcome Data > Substitute Data Source Request Submission > Substitute Data Source Request Subrecipient Detail
Cluster sampling - identify the clustering units: (If Random sample or Stratified random sample is selected)

9. The “Method of Administration” dropdown will
contain the values “Mail-in,” “Telephone,” Faceto-Face,” Self-administered: School-based,”
Self-administered: survey site other than
school,” and “Other”.

(maximum 1000 chars)

10. If “Other” is selected in the Method of
Administration field, then the “Other Method
(Specify)” field is displayed.

Multistage design - identify the unit sampled at each stage: (If Random sample or Stratified random sample is
selected)

(maximum 1000 chars)

Potential sources of bias in the sample design: (If Random sample or Stratified random sample is selected)

Method of administration:*

(maximum 1000 chars)

11 Was this a computer-assisted interview?*

What was the survey response rate?*

13 Cancel

12. Clicking the Save button will save the record
and return the user to the Substitute Data
Source Request listing page (x.x). If not all
fields required to save are completed, or invalid
data are entered, the user will be prevented
from saving and a message will list the fields
and related issues.

14. Clicking the Delete button will delete the record
and return the user to the Substitute Data
Source Request listing page (x.x).

10 Other method (specify):* (If Other is selected)

12 Save

11. The “Was this a computer assisted interview?”
field will contain the two values Yes and No.
“No” is the default.

13. Clicking the “Cancel” button will not save any
changes and will return the user to Substitute
Data Source Request listing page (x.x).

(maximum 1000 chars)

9

Page ID: x.x.x (continued)
Page Title: Substitute Data Source Request
Subrecipient Detail
Page Details

14 Delete

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Outcome Data > Substitute Data Source Request Submission > Substitute Data Source Request Supporting Documents

Substitute Data Source Request Supporting Documents
Supporting Documents
Upload documents to support your request. Include any reliability and/or validity data if possible.

No data to display

Upload file:

2 For each data file, describe the contents of the data records:*

(maximum 4000 chars)

Save

1

3. Clicking the “Save” button will save the record
and return the user to the Substitute Data
Source Request listing page (x.x). If not all
fields required to save are completed, or invalid
data are entered, the user will be prevented
from saving and a message will list the fields
and related issues.
4. Clicking the “Cancel” button will not save any
changes and will return the user to the
Substitute Data Source Request listing page
(x.x).

Upload

3

1. Clicking the “Browse” button will allow user to
search for a file from their computer. Clicking
the “Open” button will load the file name into the
Upload Agenda text field. Note: Standard file
types for the MRT are .doc, .docx., .pdf, .xls,
and .xlsx. The size limit is 10MB.
2. Regardless of the number of files uploaded, the
user receives only one field to describe the
contents of the files.

Upload documents:

Browse…

Page ID: x.x.x
Page Title: Substitute Data Source Request
Supporting Documents
Page Details

4

Cancel

5

Delete

5. Clicking the “Delete” button will delete the
record and return the user to the Substitute
Data Source Request listing page (x.x).

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Outcome Data > Substitute Data Source Request Approval

Substitute Data Source Request Review/Approval
Use this section to review your grantee's Substitute Data Source Requests. Click on the link in the Substitute
Measure Name column to review/approve the request.

1

Grantee Name

This is the Substitute Data Source listing page as
viewed by the Project Officer. Any request from
grantees tied to the project officer will be listed
here.
1. Grantee drop-down menu will contain all
programs related to the user and a default value
of “All Grantees”.
2. All requests will be organized by report status:
Submitted, Under Review, Revision Required,
Approved, and Not Approved. Each request will
have only one status at a time and will appear
on the appropriate status tab as well as on the
“All Requests” tab.

Select Grantee:

Award Number

Page ID: x.x
Page Title: Substitute Data Source Request
Approval
Page Details

Substitute Measure
Name
3

Submitter
Name

Date
Submitted

Report
Status

2

Initial
Record

Number

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3. Clicking on the “Substitute Measure Name” link
will direct the user to the review page for the
selected record (x.x.x).