25262 Federal Register / Vol. 75, No. 88 / Friday, May 7, 2010 / Notices 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration on Aging 

Agency Information Collection 

Activities; Submission for OMB 

Review; Comment Request; Extension 

of Current Program Announcement 

and Grant Application Template for 

Older Americans Act Title IV 

Discretionary Grants Program 

AGENCY: Administration on Aging, HHS. 

ACTION: Notice. 

SUMMARY: The Administration on Aging 

(AoA) is announcing that the proposed 

collection of information listed below 

has been submitted to the Office of 

Management and Budget (OMB) for 

review and clearance under the 

Paperwork Reduction Act of 1995. 

DATES: Submit written comments on the 

collection of information by June 7, 

2010. 

ADDRESSES: Submit written comments 

on the collection of information by fax 

202.395.6974 to the OMB Desk Officer 

for AoA, Office of Information and 

Regulatory Affairs, OMB. 

FOR FURTHER INFORMATION CONTACT: Lori 

Stalbaum, (202)357–3452 or 

lori.stalbam@aoa.hhs.gov. 

SUPPLEMENTARY INFORMATION: In 

compliance with 44 U.S.C. 3507, AoA 

has submitted the following proposed 

collection of information to OMB for 

review and clearance. 

AoA is requesting an extension of the 

currently approved Program 

Announcement and Application 

Instructions Template for the Older 

Americans Act Title IV Discretionary 

Grants Program. This template provides 

the requirements and instructions for 

the submission of an application for 

discretionary grants funding 

opportunities. The template may be 

found on the AoA Web site at http:// 

www.aoa.gov/AoARoot/Grants/ 

Funding/overview.aspx. 

AoA estimates the burden of this 

collection of information as follows: 

Frequency: 10–15 Title IV Program 

Announcements published annually. 

Respondents: State agencies, public 

agencies, private non-profit agencies, 

institutions of higher education, and 

organizations including tribal 

organizations. 

Estimated Number of Responses: 300 

annually. 

Total Estimated Burden Hours: 

14,400. 

Dated: May 4, 2010. 

Kathy Greenlee, 

Assistant Secretary for Aging. 

[FR Doc. 2010–10910 Filed 5–6–10; 8:45 am] 

BILLING CODE 4154–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Substance Abuse and Mental Health 

Services Administration 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

Periodically, the Substance Abuse and 

Mental Health Services Administration 

(SAMHSA) will publish a summary of 

information collection requests under 

OMB review, in compliance with the 

Paperwork Reduction Act (44 U.S.C. 

Chapter 35). To request a copy of these 

documents, call the SAMHSA Reports 

Clearance Officer on (240) 276–1243. 

Project: Cross-site Evaluation of the 

Garrett Lee Smith Memorial Suicide 

Prevention and Early Intervention 

Programs (OMB No. 0930–0286)— 

Revision 

The Substance Abuse and Mental 

Health Services Administration’s 

(SAMHSA) Center for Mental Health 

Services (CMHS) will continue to 

conduct the cross-site evaluation of the 

Garrett Lee Smith Memorial Youth 

Suicide Prevention and Early 

Intervention State/Tribal Programs and 

the Garrett Lee Smith Memorial Youth 

Suicide Prevention Campus Programs. 

The data collected through the cross-site 

evaluation addresses four stages of 

program activity: (1) The context stage 

includes a review of program plans, 

such as grantee’s target population, 

target region, service delivery 

mechanisms, service delivery setting, 

types of program activities to be funded 

and evaluation activities; (2) the product 

stage describes the prevention strategies 

that are developed and utilized by 

grantees; (3) the process stage assesses 

progress on key activities and 

milestones related to implementation of 

program plans; and (4) the impact stage 

assesses the impact of the program on 

early identification, referral for services 

and service follow up of youth at risk. 

Additionally, to obtain a 

comprehensive understanding of the 

integration of community-based 

behavioral health services with services 

provided by college or university 

campuses, SAMHSA will conduct case 

studies of four exemplary Campus 

suicide prevention programs. Currently, 

case studies of two campus grantees are 

underway. The goal of the Campus Case 

Studies is to understand how a public 

health approach is successfully applied 

as a model for campus suicide 

prevention efforts, and will explore, in 

a systematic manner: The suicide 

prevention related infrastructures and 

supports (e.g., clinical and non-clinical) 

that exist on selected GLS-funded 

campuses; the various student-level 

factors that are related to suicide 

prevention efforts (e.g., protective 

factors, coping strategies, social norms, 

and facilitators and barriers to student 

access and receipt of behavioral 

healthcare); campus interdepartmental 

collaboration and the relationship 

between various efforts to promote 

student mental health and wellness; and 

the extent to which the campus 

infrastructures and supports promote 

and address these factors. 

To date, 86 State/Tribal grants and 93 

Campus grants have participated in the 

cross-site evaluation, since FY2007. 

Currently, 48 State/Tribal grants and 38 

Campus grants are participating in the 

cross-site evaluation. Data will continue 

to be collected from suicide prevention 

program staff (e.g. project directors, 

evaluators), key program stakeholders 

(e.g. State/local officials, child-serving 

agency directors, gatekeepers, mental 

health providers, and campus 

administrators), training participants, 

college students, and campus faculty/ 

staff through FY2012. 

Since the State/Tribal grantees differ 

from the campus grantees in 

programmatic approaches, specific data 

collection activities also vary by type of 

program. The following describes the 

specific data collection activities and 

data collection instruments to be used 

across State/Tribal and Campus grantees 

for the cross-site evaluation and the 

specific data collection instruments to 

be used by selected Campus grantees for 

the Campus Case Studies. While most of 

the data collection instruments 

described below are revised versions of 

instruments that have previously 

received OMB approval (OMB No. 

0930–0286 with Expiration Date: May 

2010) and are currently in use, the 

Training Utilization and Preservation— 

Survey (TUP–S) for State/Tribal 

grantees and the Training Exit Survey 

for Campus grantees (TES–C) are 

proposed as new instruments. The 

addition of these two new data 

collection activities, the inclusion of the 

Campus Case studies, and an overall 

growth in number of grants for both the 

State/Tribal and Campus programs has 

increased the burden associated with 

the cross-site evaluation. A summary 

table of number of respondents and 


jlentini on DSKJ8SOYB1PROD with NOTICES
Federal Register / Vol. 75, No. 88 / Friday, May 7, 2010 / Notices 25263 

respondent burden has also been 

included. 

Data Collection Activities for State/ 

Tribal Grantees 

For State/Tribal grantees, the 

Prevention Strategies Inventory State/ 

Tribal (PSI ST), Training Exit Survey 

State/Tribal (TES ST), Referral Network 

Survey (RNS) and Training Utilization 

and Preservation—Interview (TUP–I) 

described below are revised versions of 

instruments that previously received 

OMB approval (OMB No. 0930–0286 

with Expiration Date: May 2010) and are 

currently in use. The Training 

Utilization and Preservation—Survey 

(TUP–S) is proposed as a new data 

collection instrument. 

• Prevention Strategies InventoryState/Tribal (PSI ST)—Revised. The 

Prevention Strategies Inventory will 

collect information on the suicide 

prevention strategies that grantees have 

developed and utilized. Prevention 

strategies include outreach and 

awareness, gatekeeper training, 

assessment and referral training for 

mental health professionals and hotline 

staff, lifeskills development programs, 

screening programs, hotlines and 

helplines, means restriction, policies 

and protocols for intervention and 

postvention, coalitions and 

partnerships, and direct services and 

traditional healing practices. Baseline 

data will be collected from the State/ 

Tribal grantees at the beginning of their 

grant cycle. Thereafter, they will 

complete the PSI ST on a quarterly basis 

over the duration of their grant period. 

Baseline data will be collected on 

information on the types of prevention 

strategies grantees have developed and 

utilized, and the follow-up data 

collection asks the grantees to update 

the information they have provided on 

a quarterly basis over the period of the 

grant. On average, 48 State/Tribal 

grantees will fill out the PSI ST per year. 

One respondent from each site will be 

responsible for completing the survey. 

The survey will take approximately 45 

minutes; however, the number of 

products, services and activities 

implemented under each strategy will 

determine the number of items each 

respondent will complete. The PSI ST 

primarily has multiple choice questions 

with several open-ended questions. 

• Training Exit Survey State-Tribal 

Version (TES ST)—Revised. The TES ST 

will be administered to all participants 

in suicide prevention training activities 

immediately following their training 

experience in order to assess the content 

of the training, the participants’ 

intended use of the skills and 

knowledge learned and satisfaction with 

the training experience. The survey will 

also contain modules with questions 

tailored to specific types of training. It 

is estimated that approximately 94,848 

trainees per year will respond to the 

TES ST. The questions on the TES ST 

are multiple-choice, Likert-scale, and 

open-ended. The survey includes about 

33 items and will take approximately 10 

minutes to complete. 

• Training Exit Survey Cover Page 

State/Tribal Version (TES CP)— 

Revision. State and Tribal grantees are 

required to report aggregate training 

participant information for all training 

conducted as part of their suicide 

prevention programs. These data are 

aggregated from existing data sources, 

some of which are attendance sheets, 

management information systems, etc. 

Grantees are responsible for aggregating 

these data and submitting to the crosssite evaluation team using the TES CP. 

• Training Utilization and 

Preservation Survey (TUP–S)—New. The 

Training Utilization and Preservation 

Survey (TUP–S) is a quantitative, 

computer-assisted telephone interview 

that will be administered to a random 

sample of trainees two months 

following the training. The TUP–S will 

assess trainee knowledge retention and 

gatekeeper behavior, particularly 

behavior related to identifying youth at 

risk. The TUP–S will ask trainees to 

provide demographic information about 

individuals they have identified at risk, 

information about the subsequent 

referrals or supports provided by the 

trainee, and any available information 

about services accessed by the at-risk 

individual. An average of 2000 

participants per year will be sampled. 

The TUP–S includes 26 items and will 

take approximately 10 minutes to 

complete. 

• Training Utilization and 

Preservation Key Informant Interview 

(TUP–1)—Revision. The TUP–I is a 

qualitative follow-up interview that is 

targeted towards locally developed and 

understudied standardized training 

curricula as well as towards particular 

understudied gatekeeper trainee 

populations. The TUP–I will be 

administered to respondents two 

months following the training 

experience to assess whether the suicide 

prevention knowledge, skills or 

techniques learned through training 

were utilized and had an impact on 

youth. On average, the TUP–I will be 

administered to 100 respondents per 

year. The interviews are semistructured 

and open ended. The TUP includes 22 

items and will take approximately 40 

minutes to complete. 

• Referral Network Survey (RNS)— 

Revision. The Referral Network Survey 

(RNS) will be administered to 

representatives of youth-serving 

organizations or agencies that form 

referral networks supporting youth 

identified at risk. The RNS examines 

how collaboration and integration are 

used for sharing and transferring 

knowledge, resources, and technology 

among State/Tribal Program agencies 

and organizational stakeholders, how 

these networks influence referral 

mechanisms and service availability, 

policies and protocols regarding followup for youths who have attempted 

suicide and who are at risk for suicide, 

and access to electronic databases. Most 

State/Tribal grantees will select a single 

referral network for this survey, the 

average size of the network is 11 

agencies/organizations and there will be 

2 respondents per agency. The RNS will 

be administered to referral networks on 

an annual basis over the period of the 

grant. On average, 1056 respondents per 

year will complete the RNS. Questions 

on the RNS are multiple-choice, Likertscale, and open-ended. The RNS 

includes 28 items and will take 

approximately 30 minutes to complete. 

• Early Identification, Referral and 

Follow up Aggregate Screening Form— 

State/Tribal grantees are also required to 

report aggregate screening information 

for all youth screened as part of their 

suicide prevention programs. These data 

are aggregated from existing data 

sources. Grantees are responsible for 

aggregating these data and submitting to 

the cross-site evaluation team using the 

Early Identification, Referral and Follow 

up Aggregate Screening Form. 

• Early Identification, Referral and 

Follow Up Analyses—State/Tribal 

grantees are required to share existing 

data with the cross-site evaluation team 

on the number of youth identified at 

risk as a result of early identification 

activities, referred for services, and who 

present for services. 

Data Collection Activities for Campuses 

For Campus grantees, the Prevention 

Strategies Inventory-Campus Baseline 

and Follow Up (PSI C), Suicide 

Prevention Exposure, Awareness and 

Knowledge Survey—Student Version 

(SPEAKS–S), Suicide Prevention 

Exposure, Awareness and Knowledge 

Survey—Faculty/Staff Version 

(SPEAKS–FS) and Campus 

Infrastructure Interviews (CIFI) are 

revised versions of instruments that 

previously received OMB approval 

(OMB No. 0930–0286 with Expiration 

Date: May 2010) and are currently in 

use, and the Training Exit Survey— 

Campus (TES C) is proposed as a new 

data collection instrument. 


jlentini on DSKJ8SOYB1PROD with NOTICES
25264 Federal Register / Vol. 75, No. 88 / Friday, May 7, 2010 / Notices 

• Prevention Strategies InventoryCampus (PSI C)—Revision. The 

Prevention Strategies Inventory will 

collect information on the suicide 

prevention strategies that grantees have 

developed and utilized. Prevention 

strategies include outreach and 

awareness, gatekeeper training, 

assessment and referral training for 

mental health professionals and hotline 

staff, lifeskills development activities, 

screening programs, hotlines and 

helplines, means restriction, policies 

and protocols for intervention and 

postvention, and coalitions and 

partnerships. The Campus grantees will 

first complete collecting baseline data. 

Thereafter, they will collect follow-up 

data on a quarterly basis over the 

duration of their grant period. Baseline 

data will be collected on information on 

the types of prevention strategies 

grantees have developed and utilized, 

and the follow-up data collection asks 

the grantees to update the information 

they have provided on a quarterly basis 

over the period of the grant. On average, 

38 Campus grantees will fill out the PSI 

C per year. One respondent from each 

site will be responsible for completing 

the survey. The survey will take 

approximately 45 minutes. However, 

the number of products, services and 

activities implemented under each 

strategy will determine the number of 

items to complete. The survey primarily 

has multiple choice questions with 

several open-ended questions. 

• Training Exit Survey Campus 

Version (TES C)—New. The TES C will 

be administered to all participants in 

suicide prevention training activities 

immediately following their training 

experience in order to assess the content 

of the training, the participants’ 

intended use of the skills and 

knowledge learned, and satisfaction 

with the training experience. The survey 

will also contain modules with 

questions tailored to specific types of 

training. It is estimated that 

approximately 23,712 trainees per year 

will respond to the Training Exit 

Survey. The questions on the TES C are 

multiple-choice, Likert-scale, and openended. The survey includes about 33 

items and will take approximately 10 

minutes to complete. 

• Training Exit Survey Cover Page 

Campus Version (TES CP)—Revision. 

State and Tribal grantees are required to 

report aggregate training participant 

information for all training conducted as 

part of their suicide prevention 

programs. These data are aggregated 

from existing data sources, some of 

which are attendance sheets, 

management information systems, etc. 

Grantees are responsible for aggregating 

these data and submitting to the crosssite evaluation team using the TES CP. 

• Suicide Prevention Exposure, 

Awareness and Knowledge Survey— 

Student Version (SPEAKS–S)—Revision. 

This survey will examine: The exposure 

of campus populations to suicide 

prevention initiatives; awareness of 

appropriate crisis interventions, 

supports, services, and resources for 

mental health seeking; knowledge of 

myths and facts related to suicide and 

suicide prevention; perceived and 

personal stigma related to depression 

and mental health seeking; and 

behaviors related to seeking help and 

referring for mental health services. This 

survey will be administered annually 

over the grant period. It is estimated that 

7,600 students per year will respond to 

the SPEAKS S. The SPEAKS–S is Webbased and includes multiple-choice, 

Likert-scale and true/false questions. 

The SPEAKS–Student Version includes 

85 items and will take approximately 25 

minutes to complete. 

• Suicide Prevention Exposure, 

Awareness and Knowledge Survey— 

(SPEAKS FS)—Revision. The SPEAKS– 

FS assesses the exposure, awareness and 

knowledge of suicide prevention 

activities among faculty/staff on campus 

as a result of the suicide prevention 

program. Questions include whether 

faculty/staff have been exposed to 

suicide prevention materials, their 

agreement with myths and facts about 

suicide, and the availability of resources 

to provide assistance to those at risk for 

suicide. This survey will be 

administered annually over the grant 

period. It is estimated that 1,900 faculty/ 

staff per year will respond to the 

SPEAKS FS. The SPEAKS–FS is Webbased and includes multiple-choice, 

Likert-scale and true/false questions. 

The survey includes 54 items and will 

take approximately 15 minutes to 

complete. 

• Campus Infrastructure Interviews 

(CIFI)—Revision. CIFI is designed to 

gather information around campus 

infrastructure, program, policy, and 

planning related to suicide prevention; 

it involves key informant interviews 

conducted by the cross-site evaluation 

team via teleconference for each campus 

twice during the life of the grant. These 

semistructured interviews are 

conducted with up to five site 

representatives to gather information 

from multiple and varied perspectives 

on campus-based infrastructure 

development around suicide prevention 

activities. These representatives 

include: (1) Administrator, (2) Student 

Leader, (3) Counseling Center Staff, (4) 

Faculty/Staff-human services 

department, and (5) Faculty/Staff-nonhuman service department. Questions 

on the Campus Infrastructure Interview 

include whether respondents are aware 

of suicide prevention activities, what 

the campus culture is related to suicide 

prevention, and what specific efforts are 

in place to prevent suicide among the 

campus population. Questions will 

include close-ended background 

questions, with the remaining questions 

being open-ended and semi-structured. 

It is estimated that on average 64 

respondents per year will respond to 

CIFI. The Campus Infrastructure 

Interviews include 29 items and will 

take approximately 60 minutes to 

complete. 

Data Collection Activities for Campus 

Case Studies 

For Campus Case Studies, the 

instruments described below are 

currently used by 2 Campus grantees. 

These instruments are proposed for 4 

additional Campus grantees. The 

Campus Case Studies will take place 

over the period of the grant. 

• Student Focus Group Moderator’s 

Guide. This component will assess 

student risk and protective factors 

related to mental health, help-seeking 

behaviors, and knowledge of prevention 

activities on campus and their perceived 

effectiveness. This will help researchers 

more fully understand student-level 

factors in relation to population-level 

factors addressed by the SPEAKS–S. 

Questions address stressors that 

different groups of students face while 

in college, barriers to seeking help, 

attitudes and stigma related to seeking 

help, and the accessibility of the 

campus counseling center. Six focus 

groups will be conducted on each 

campus twice over the data collection 

period. The following groups of 

students will potentially be represented 

in the focus groups, as decided by the 

campus: (1) First-year students, (2) 

athletes, (3) international students, (4) 

Lesbian, Gay, Bisexual, and Transgender 

(LGBT) students, (5) Greek life students, 

(6) graduate students, and (7) residential 

advisors/peer educators. Recruitment 

will be conducted by campus project 

staff. Focus groups will include a 

maximum of 9 students. It is estimated 

that on average 432 students will 

participate in focus groups. Groups will 

last approximately 90 minutes. 

• Faculty/Staff Focus Group 

Moderator’s Guide. The faculty and staff 

focus groups will assess the campus’ 

approach to prevention, attitudes and 

stigma around student mental health 

and wellness on campus, campus 

infrastructure supports for students who 

need mental health help, and the 

general campus climate around mental 


jlentini on DSKJ8SOYB1PROD with NOTICES
Federal Register / Vol. 75, No. 88 / Friday, May 7, 2010 / Notices 25265 

health and wellness. Faculty and staff 

will also describe their knowledge of 

prevention activities on campus and 

their perceived effectiveness of these 

efforts. Local campus staff will recruit 

appropriate respondents for the faculty 

and staff focus groups to include a 

maximum of 9 respondents per group. 

Two faculty focus groups and one staff 

focus group will be conducted on each 

campus twice over the period of data 

collection. It is estimated that 216 

faculty/staff will participate in focus 

groups. The groups will last 

approximately 90 minutes. 

• Case Study Key Informant 

Interviews (7 versions). The Case Study 

Key Informant Interviews (CSIs) include 

7 qualitative interview versions: (1) 

Administrator, (2) Counseling Staff, (3) 

Coalition Member—Faculty, (4) 

Prevention Staff, (5) Case Finder, (6) 

Campus Police, and (7) Student Leader. 

Local project staff will be responsible 

for identifying appropriate respondents 

for each CSI version and scheduling the 

interview to occur during site visits by 

the case study team. Fourteen 

individuals from each of the campus 

sites will be selected as key informants 

to participate in the CSIs in each of the 

two stages of the GLS Campus Case 

Studies. Questions on the CSIs include 

whether respondents are aware of 

suicide prevention activities, what the 

campus culture is related to suicide 

prevention, and what specific efforts are 

in place to prevent suicide among the 

campus population. Items are formatted 

as open-ended and semi-structured 

questions. The CSIs include 16 to 21 

items and will take approximately 60 

minutes to complete. On the second site 

visit, the case study team will 

incorporate preliminary findings from 

the case studies in the interviews, 

which may be modified to some extent 

to collect more comprehensive 

information and gather feedback from 

local key informants surrounding the 

context of the preliminary findings. It is 

estimated that the CSI will be 

administered to 112 respondents. The 

CSIs for the second site visit will last 60 

minutes. 

In addition to the above described 

data collection activities, data from 

existing sources (i.e., management 

information systems (MIS), 

administrative records, case files, etc.) 

will continue to be analyzed across 

grantee sites to support the impact stage 

of the cross-site evaluation. For the 

cross-site evaluation of the Campus 

programs, existing program data related 

to the number of students who are at 

risk for suicide, the number who seek 

services, and the type of services 

received are analyzed to determine the 

impact of Campus program activities on 

the student and campus populations. 

Because this information is obtained 

through existing sources, data collection 

instruments were not developed as part 

of the cross-site evaluation and no 

identifiable respondents exist; therefore 

no respondent burden has been 

estimated. 

Internet-based technology will 

continue to be used for collecting data 

via Web-based surveys, and for data 

entry and management. The average 

annual respondent burden is estimated 

below. The estimate reflects the average 

annual number of respondents, the 

average annual number of responses, the 

time it will take for each response, and 

the average annual burden. While the 

different cohorts of grantees finish their 

grants at different times, we have 

assumed that new cohorts will replace 

previous cohorts. Therefore, the number 

of grantees in each year is assumed to 

be constant. 

TABLE—ESTIMATES OF ANNUALIZED HOUR BURDEN

Measure name Number of 

respondents 

Number of 

responses/respondent Hours/response 

Response 

burden 

(in hours) 

Prevention Strategies Inventory—State Tribal (PSI–ST) ........ 48 4 0 .75 144 

Training Exit Survey State/Tribal (TES–ST) ............................ 94,848 1 0 .17 16,125 

Training Utilization and Penetration Survey (TUP–S) ............. 2,000 1 0 .25 500 

Training Utilization and Penetration Interview (TUP–I) ........... 100 1 0 .67 67 

Referral Network Survey (RNS) .............................................. 1,024 1 0 .67 687 

Early Identification, Referral and Follow Up Analysis (EIRF) .. 48 4 1 192 

Early Identification, Referral and Follow Up Aggregate 

Screening Form (EIRF–S) ................................................... 48 4 0 .33 64 

Training Exit Survey Cover Page State/Tribal (TES–CP–ST) 48 4 0 .33 64 

Prevention Strategies Inventory-Campus (PSI–C) .................. 38 4 0 .75 114 

Training Exit Survey Campus (TES–C) ................................... 23,712 1 0 .17 4,032 

Suicide Prevention Exposure, Awareness and Knowledge 

Survey-Student Version (SPEAKS–S) ................................. 7,600 1 0 .42 3,192 

Suicide Prevention Exposure, Awareness and Knowledge 

Survey-Faculty/Staff (SPEAKS–FS) .................................... 1,900 1 0 .25 475 

Campus Infrastructure Interview (CIFI) for Student ................ 38 1 0 .75 29 

Campus Infrastructure Interview (CIFI) for Faculty ................. 76 1 0 .75 57 

Campus Infrastructure Interview (CIFI) for Administrator ........ 38 1 0 .75 29 

Campus Infrastructure Interview (CIFI) for Counselor ............ 38 1 0 .75 29 

Training Exit Survey Cover Page Campus (TES–CP–C) ....... 38 4 0 .33 51 

MIS Data Abstraction ............................................................... 38 4 0 .33 51 

Focus Group—Student Version ............................................... 216 1 1 .5 324 

Focus Group—Faculty Version ............................................... 72 1 1 .5 108 

Focus Group—Staff Version .................................................... 36 1 1 .5 54 

Interview—Student Leader Version ......................................... 8 1 1 8 

Interview—Case Finder Version .............................................. 4 1 1 4 

Interview—Faculty Version ...................................................... 8 1 1 8 

Interview—Campus Police Version ......................................... 8 1 1 8 

Interview—Counseling Staff Version ....................................... 8 1 1 8 

Interview—Prevention Staff Version ........................................ 12 1 1 12 

Interview—Administrator Version ............................................ 8 1 1 8 

Total .................................................................................. 132,060 .............................................. .......................... 26,444 


jlentini on DSKJ8SOYB1PROD with NOTICES
25266 Federal Register / Vol. 75, No. 88 / Friday, May 7, 2010 / Notices 

Written comments and 

recommendations concerning the 

proposed information collection should 

be sent by June 7, 2010 to: SAMHSA 

Desk Officer, Human Resources and 

Housing Branch, Office of Management 

and Budget, New Executive Office 

Building, Room 10235, Washington, DC 

20503; due to potential delays in OMB’s 

receipt and processing of mail sent 

through the U.S. Postal Service, 

respondents are encouraged to submit 

comments by fax to: 202–395–6974. 

Dated: April 28, 2010. 

Elaine Parry, 

Director, Office of Program Services. 

[FR Doc. 2010–10907 Filed 5–6–10; 8:45 am] 

BILLING CODE 4162–20–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–901A and 901D] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 

In compliance with the requirement 

of section 3506(c)(2)(A) of the 

Paperwork Reduction Act of 1995, the 

Centers for Medicare & Medicaid 

Services (CMS) is publishing the 

following summary of proposed 

collections for public comment. 

Interested persons are invited to send 

comments regarding this burden 

estimate or any other aspect of this 

collection of information, including any 

of the following subjects: (1) The 

necessity and utility of the proposed 

information collection for the proper 

performance of the agency’s functions; 

(2) the accuracy of the estimated 

burden; (3) ways to enhance the quality, 

utility, and clarity of the information to 

be collected; and (4) the use of 

automated collection techniques or 

other forms of information technology to 

minimize the information collection 

burden. 

1. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Federal 

Qualification Application (42 CFR 

417.140) and Medicare Health Care 

Prepayment Plan Application (42 CFR 

417.800); Use: The application is the 

collection form used to obtain 

information to determine if an applicant 

meets the regulatory requirements to 

enter into a contract with CMS as a 

Federal Qualified health maintenance 

organization (HMO) or to provide health 

benefits to Medicare beneficiaries as a 

Medicare Health Care Prepayment Plan 

contractor. Form Number: CMS–901A & 

901D (OMB#: 0938–0470); Frequency: 

Once; Affected Public: Business or other 

for-profits and Not-for-profit 

institutions; Number of Respondents: 

20; Total Annual Responses: 20; Total 

Annual Hours: 800 (For policy 

questions regarding this collection 

contact Heidi Arndt at 410–786–1607. 

For all other issues call 410–786–1326.) 

To obtain copies of the supporting 

statement and any related forms for the 

proposed paperwork collections 

referenced above, access CMS’ Web site 

at http://www.cms.hhs.gov/ 

PaperworkReductionActof1995, or 

E-mail your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov, or call the 

Reports Clearance Office on (410) 786– 

1326. 

In commenting on the proposed 

information collections please reference 

the document identifier or OMB control 

number. To be assured consideration, 

comments and recommendations must 

be submitted in one of the following 

ways by July 6, 2010: 

1. Electronically. You may submit 

your comments electronically to http:// 

www.regulations.gov. Follow the 

instructions for ‘‘Comment or 

Submission’’ or ‘‘More Search Options’’ 

to find the information collection 

document(s) accepting comments. 

2. By regular mail. You may mail 

written comments to the following 

address: CMS, Office of Strategic 

Operations and Regulatory Affairs, 

Division of Regulations Development, 

Attention: Document Identifier/OMB 

Control Number, Room C4–26–05, 7500 

Security Boulevard, Baltimore, 

Maryland 21244–1850. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2010–10623 Filed 5–6–10; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

[Document Identifier: CMS–10293] 

Centers for Medicare & Medicaid 

Services; Agency Information 

Collection Activities: Submission for 

OMB Review; Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services. 

In compliance with the requirement 

of section 3506(c)(2)(A) of the 

Paperwork Reduction Act of 1995, the 

Centers for Medicare & Medicaid 

Services (CMS), Department of Health 

and Human Services, is publishing the 

following summary of proposed 

collections for public comment. 

Interested persons are invited to send 

comments regarding this burden 

estimate or any other aspect of this 

collection of information, including any 

of the following subjects: (1) The 

necessity and utility of the proposed 

information collection for the proper 

performance of the Agency’s function; 

(2) the accuracy of the estimated 

burden; (3) ways to enhance the quality, 

utility, and clarity of the information to 

be collected; and (4) the use of 

automated collection techniques or 

other forms of information technology to 

minimize the information collection 

burden. 

1. Type of Information Collection 

Request: New Collection; Title of 

Information Collection: Tribal 

Consultation State Plan Amendment 

Template; Use: Effective July 1, 2009, 

section 5006 of the American Recovery 

and Reinvestment Act of 2009 (Recovery 

Act) amended section 1902(a)(73) of the 

Act to require that certain States utilize 

a process for the State to seek advice on 

a regular, ongoing basis from designees 

of the Indian Health Service (IHS) and 

Urban Indian Organizations concerning 

Medicaid and Children’s Health 

Insurance Program (CHIP) matters 

having a direct effect on them. The 

consultation process is required for the 

37 States in which 1 or more Indian 

Health Programs or Urban Indian 

Organizations furnish health care 

services. The State Medicaid agency for 

each of these States will complete the 

template page and submit it for approval 

as part of a State plan amendment, to 

document how it meets the 

requirements for tribal consultation. 

Form Number: CMS–10293 (OMB#: 

0938–NEW); Frequency: Reporting— 

Once and occasionally; Affected Public: 

State, Local, or Tribal Governments; 

Number of Respondents: 37; Total 

Annual Responses: 37; Total Annual 

Hours: 37. (For policy questions 

regarding this collection contact Lane 

Terwilliger at 410–786–2059. For all 

other issues call 410–786–1326.) 

To obtain copies of the supporting 

statement and any related forms for the 

proposed paperwork collections 

referenced above, access CMS Web Site 

address at http://www.cms.hhs.gov/ 

PaperworkReductionActof1995, or Email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 


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