OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

State Opioid Response (SOR) and Tribal Opioid Response (TOR) Program Data Collection and Performance Measurement

ICR 201812-0930-001 · OMB 0930-0384 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form Grantee-Level Inst Grantee-Level Instrument Form and Instruction New Repair queued
Attachment E - SOR TOR Responses 12.20.18.xlsx Supplementary Document Uploaded 2018-12-20 Repair queued
Attachment D - SOR TOR Comments 12.20.18.pdf Supplementary Document Uploaded 2018-12-20 Available
SOR TOR OMB SS-B 12.10.2018.docx Supporting Statement B Uploaded 2018-12-10 Available
SOR TOR OMB SS-A 12.10.2018.docx Supporting Statement A Uploaded 2018-12-10 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
234465 Grantee-Level Instrument Form and Instruction New
ICR Details
0930-0384 201812-0930-001
Active
HHS/SAMHSA
State Opioid Response (SOR) and Tribal Opioid Response (TOR) Program Data Collection and Performance Measurement
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 06/13/2019
Retrieve Notice of Action (NOA) 12/21/2018
Approval is granted for the grantee-Level Instrument, but not for the client-level data collection tools.
  Inventory as of this Action Requested Previously Approved
06/30/2022 36 Months From Approved
1,436 0 0
244 0 0
0 0 0
There will be up to 359 award recipients (states, territories, and tribal entities) in these grant programs. Grantee-level data will include information related to naloxone purchases and distribution. This grantee-level information will be collected quarterly. All funded states/territories and tribal entities will also be required to collect and report client-level data on individuals who are receiving opioid treatment services to ensure program goals and objectives are being met. Client-level data will include information such as: demographic information, services planned/received, mental health/substance use disorder diagnoses, medical status, employment status, substance use, legal status, and psychiatric status/symptoms. Client level data will be collected at intake/baseline, three months post intake, six months post intake, and at discharge.
US Code: 42 USC 1105 Name of Law: GPRA
  
None
Not associated with rulemaking
  83 FR 50116 10/04/2018
83 FR 63521 12/10/2018
Yes
1
IC Title Form No. Form Name
Grantee-Level Instrument Grantee-Level Instrument Grantee-Level Instrument
  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 1,436 0 0 1,436 0 0
Annual Time Burden (Hours) 244 0 0 244 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new data collection.
$265,000
Yes Part B of Supporting Statement
    No
    No
No
No
No
Uncollected
Summer King 2402761243
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/21/2018