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OMB No. 0930-03xx

Expiration Date: xx/xx/2020

Burden Statement: This information is being collected to assist the Substance Abuse and Mental Health Services Administration (SAMHSA) for the purpose of program monitoring of the Technology Transfer Centers (TTC) Network Program. This voluntary information collected will be used at an aggregate level to determine the reach, consistency, and quality of the TTC Program. Under the Privacy Act of 1974 any personally identifying information obtained will be kept private to the extent of the law. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid Office of Management and Budget (OMB) control number. The OMB control number for this project is 0930-03xx. Public reporting burden for this collection of information is estimated to average less than 10 minutes per encounter, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Ln, Room 15 E57B, Rockville, MD 20857.

TTC Performance Monitoring Information Summary

The event in which you are about to participate is provided through the [Name of TTC site], a program funded through the Substance Abuse and Mental Health Services Administration’s (SAMHSA). As part of receiving this funding, we are required to submit data on the types of persons participating in this event and to monitor the performance of this event.

You will be asked to complete two short performance monitoring surveys about this event. Right after the training ends, you will be asked to fill out an Event Form. This form asks basic demographic information and asks you to rate your current knowledge and skills in the topic area of the event. Thirty days after the completion of this event, if you have agreed to be contacted for a Post Event survey, you may receive a Post Event Follow-up Form. The Post Event Follow-up Form asks similar questions to the Event Form, and also asks if you have had the opportunity to share the information or materials you received through the event with coworkers.

Each of the surveys is brief, and should only take a few moments to complete. The information collected is used not only to comply with funding requirements, but also to improve the activities provided by [Name of TTC site]. Your participation in the completion of these surveys is entirely voluntary. There are no negative consequences to you should you decide not to complete any or all of these surveys. You can decide not to complete them at any time. However, your feedback is critical for the TTC Network to continue to provide no-cost or low-cost events.

Each of the surveys asks a series of questions at the top of the page to create an individual code. This code will be used to link each of the surveys together, so you do not need to put your name on any of the survey materials. This keeps your responses private. Only aggregated responses will be reported in performance monitoring reports and documents.