National Evaluation the Protection and Advocacy for Individuals with Mental Illness (PAIMI) Program

Forms and Documents

Document Name	Status
Form Appendix II - Surv PAIMI Client Survey Form and Instruction	New
Form Appendix II - Surv Surveys - Form and Instruction	New
Form Appendix II - Surv Executive Director Interview Form and Instruction	New
PAIMI.doc Supplementary Document	2008-01-09
PAIMI Eval Supporting Statement 07 13 07.doc Supporting Statement B	2007-07-13
Attachment IV NASMHPD Comments.doc Supplementary Document	2007-07-13
Attachment IV Arkansas P&A Comment.tif Supplementary Document	2007-07-13
Attachment III Survey Recommendations & Changes as per FRN.doc Supplementary Document	2007-07-13
PAIMI Eval Supporting Statement 07 13 07.doc Supporting Statement A	2007-07-13

IC Document Collections

IC ID	Document Title	Status
181322	PAIMI Client Survey Form and Instruction	New
181321	Surveys - Form and Instruction	New
181320	Executive Director Interview Form and Instruction	New

ICR Details

OMB Control No: 0930-0287	ICR Reference No: 200707-0930-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: National Evaluation the Protection and Advocacy for Individuals with Mental Illness (PAIMI) Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/10/2008
	Date Received in OIRA: 07/26/2007
Terms of Clearance: Approved consistent with SAMHSA response to OMB comments. Approved for a period of two years after which SAMHSA shall resubmit to OMB for review including a discussion of the results during the current clearance period and outlining plans for long term follow up of subjects.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2010	36 Months From Approved
Responses	172	0	0
Time Burden (Hours)	156	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This evaluation requests clearance of five separate data collection instruments: 1) Interview with P&A Executive Directors; 2) Survey of PAIMI Advisory Council Chairs; 3) Survey of PAIMI Clients; 4) Survey of State Mental Health Authority Directors; 5) Survey of Directors of Other Mental Health Advocacy Organizations (the latter to be nominated by the P&A Director, one of which will be a consumer run organization).

---

Authorizing Statute(s): US Code: 42 USC 290bb-31 Name of Law: PAIMI Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 4367	01/26/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 38837	07/16/2007
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Executive Director Interview	Appendix II - Surveys/Interviews	Appendix II - Surveys/Interviews
Surveys -	Appendix II - Surveys/Interviews	Appendix II - Surveys/Interviews
PAIMI Client Survey	Appendix II - Surveys/Interviews	Appendix II - Surveys/Interviews

---

ICR Summary of Burden

	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	172	0	0	172	0	0
Annual Time Burden (Hours)	156	0	0	156	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new data collection.

---

Annual Cost to Federal Government: $128,500

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

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

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

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

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(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: 07/26/2007

---