Forms and Documents

Document Name	Status
BEES nonsub change request memo_Aug 2022.docx Justification for No Material/Nonsubstantive Change	2022-08-22
NonSub Memo_BEES BL ToA and 12 - 18 Mos Tailored Part Survey_July 2022.docx Justification for No Material/Nonsubstantive Change	2022-07-25
Memo_BEES OMB Package_December 2021_Clean_2.docx Justification for No Material/Nonsubstantive Change	2021-12-21
NonSub Change Memo_BEES Franklin Stark 6 Month Follow Up_August 2021.docx Justification for No Material/Nonsubstantive Change	2021-08-31
Memo_BEES OMB Package_May 2021_v2.docx Justification for No Material/Nonsubstantive Change	2021-05-12
Memo_BEES OMB Package_Nov-Dec 2020_Final.docx Justification for No Material/Nonsubstantive Change	2020-12-29
NonSub Change Memo_BEES_August 2020.docx Justification for No Material/Nonsubstantive Change	2020-08-28
BEES_NonSub Change Request3_Memo_April 2020_final.docx Justification for No Material/Nonsubstantive Change	2020-04-10
BEES_NonSub Change Request2_Memo_Generic and ARC BIF_March 2020.docx Justification for No Material/Nonsubstantive Change	2020-03-16
BEES_NonSub Change Request_Memo_Generic and ARC BIF_Feb 2020 final.docx Justification for No Material/Nonsubstantive Change	2020-02-20
S_Phase II Burden Table.docx Supplementary Document	2019-11-08
T_BEES 60-Day Federal Register Notice_posted.pdf Supplementary Document	2019-11-08
R_6- and 12- to 18-Month Survey Flyer_Phase 2_CLEAN.docx Supplementary Document	2020-08-28
Q_6- and 12- to 18-Month Survey Email Reminder_Phase 2_CLEAN.docx Supplementary Document	2020-08-28
P_6- and 12- to 18-Month Survey Advance Letter_Phase 2_CLEAN.docx Supplementary Document	2020-08-28
I_Welcome Letter_final 11.8.19.docx Supplementary Document	2019-11-08
H_ Informed Consent Form for Participants_Change Request_CLEAN.docx Supplementary Document	2020-08-28
BEES_Supporting Statement B_July 2020_CLEAN.docx Supporting Statement B	2020-08-28
BEES_Supporting Statement A_July 2022_2_clean.docx Supporting Statement A	2022-07-25

IC Document Collections

IC ID	Document Title	Status
243389	Program Staff Survey (Attachment O) Other-Staff Survey	Unchanged
243388	Participant Case Study Interview Guide (Attachment M) Other-Interview Guide	Unchanged
243387	Program Staff Case Study Interview Guide (Attachment N) Other-Interview Guide	Unchanged
243386	Program Managers, Staff, and Partners Interview Guide (Attachment L) Other-Interview Guide	Unchanged
243385	12-Month Follow-Up Participant Interview (Attachment K) Other-Participant Survey	Modified
243384	6-Month Follow-Up Participant Interview (Attachment J) Other-Participant Survey	Unchanged
238507	Program managers, staff, and partner interview guide - Whole Family Approach Programs (Attachment G) Other-	Unchanged
235600	Program managers, staff, and partner interview guide - SUD Programs (Attachment F) Other-	Unchanged
235599	Discussion guide for program staff at potential sites (Attachment C) Other-	Unchanged
235598	Discussion guide for state and local administrators (Attachment B) Other-	Unchanged
235597	Discussion guide for national policy experts and researchers (Attachment A) Other-	Unchanged
235593	Contact update request form (Attachment E) Other-	Unchanged
235592	Baseline information form for participants (Attachment D) Other-Standard BIF	Unchanged

ICR Details

OMB Control No:	ICR Reference No:
Status:	Previous ICR Reference No:
Agency/Subagency:	Agency Tracking No:
Title:
Type of Information Collection:	Common Form ICR:
Type of Review Request:	Date Received in OIRA:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract:

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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:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR?

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Number of Information Collection (IC) in this ICR: 0

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ICR Summary of Burden

	Total	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	0	0	0	0	0	0
Annual Time Burden (Hours)	0	0	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion:

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion:

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods?

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.    

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.    

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?

Is this ICR related to the Pandemic Response?

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Common Form ICR: 

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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:

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