The Mental Health Transformation State Incentive Grant Cross-Site Evaluation

Forms and Documents

Document Name	Status
Form Attachments 1-13 The Mental Health Transformation state Incentive Grant Cross-Site Evaluation Form and Instruction	New
OMB_Supporting_Statement-12-19-07.doc Supporting Statement B	2007-12-19
OMB_Supporting_Statement-12-19-07.doc Supporting Statement A	2007-12-19

IC Document Collections

IC ID	Document Title	Status
183237	The Mental Health Transformation state Incentive Grant Cross-Site Evaluation Form and Instruction	New

ICR Details

OMB Control No: 0930-0292	ICR Reference No: 200801-0930-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: The Mental Health Transformation State Incentive Grant Cross-Site Evaluation
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: 05/19/2008
	Date Received in OIRA: 01/03/2008
Terms of Clearance: Approved consistent with SAMHSA revisions to the collection outlined in Agency memo submitted to OMB and included in the public docket.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2011	36 Months From Approved
Responses	2,133	0	0
Time Burden (Hours)	1,586	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The cross-site evaluation project will evaluate the effectiveness of the MHT SIG program for nine State grantees. The data collection associated with this evaluation is as follows: Key Personnel Interviews (using discussion guides developed for this program); leadership Surveys (using an existing survey instrument); Consumer and Family Member Involvement Interviews (using a form developed for this evaluation); GPRA Infrastructure Indicators (entered by States into a web-based data collection system using forms developed for this program); Mental Health Provider Interviews (using form developed for this evaluation); Recovery and Resilience Measurement Surveys (using existing recovery and resilience instruments as selected by the grantee States, along with modifications of OMB-approved National Outcome Measures--NOMs--questions for CMHS discretionary grant programs).

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Authorizing Statute(s): US Code: 5 USC 501 Name of Law: SAMHSA
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 47056	08/22/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 71935	12/19/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
The Mental Health Transformation state Incentive Grant Cross-Site Evaluation	Attachments 1-13	Attachments 1-13

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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	2,133	0	0	2,133	0	0
Annual Time Burden (Hours)	1,586	0	0	1,586	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.

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Annual Cost to Federal Government: $739,924

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

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Common Form ICR:  No

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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: 01/03/2008

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