Behavioral Health Preventive Care Assessment Focus Group

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Data Entry Group- Behavioral Health Preventive Care	Form and Instruction	New	Repair queued
Administrator Group-Behavioral Health Preventive Care	Form and Instruction	New	Repair queued
Form no form number Provider Group-Behavioral Health Preventive Care	Form and Instruction	New	Repair queued
BHPC OMB Supporting Statement final dec 18 2008.doc	Supporting Statement A	Uploaded 2008-12-03	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
187559	Data Entry Group- Behavioral Health Preventive Care	Form and Instruction	New
187558	Administrator Group-Behavioral Health Preventive Care	Form and Instruction	New
187557	Provider Group-Behavioral Health Preventive Care	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 200812-0917-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/IHS	Agency Tracking No:
Title: Behavioral Health Preventive Care Assessment Focus Group
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 04/01/2009
	Date Received in OIRA: 12/17/2008
Terms of Clearance: HHS/IHS will resubmit this collection as a regular, new ICR, not a Generic ICR.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The IHS goal is to raise the health status of the American Indian and Alaska Native people to the highest possible level by providing comprehensive health care and preventive health services. To support this mission, IHS uses the Government Performance and Results Act (GPRA) to assess quality of care among its federal, urban, and tribal health programs. The IHS has been largely successful in meeting GPRA targets for selected clinical performance measures at the national level. However, there is significant variability in performance among IHS and tribal service units. Until this time, IHS has not undertaken any comprehensive studies to evaluate the reasons for that variability or the factors that contribute to high quality care at the local level. The IHS has three GRPA measures relating to behavioral health, a high priority for the Agency and one of the IHS Director's Initiatives. This study will focus on these three GPRA behavioral health measures: Depression Screening in adults age 18 and over, Domestic/Intimate Partner Violence screening in women ages 15-40, and Alcohol Screening (to prevent Fetal Alcohol Syndrome) in women ages 15-44. IHS has developed a methodology to identify superior and poor performers on these measures at both Tribal and Federal sites using FY 2005, 2006 and 2007 GPRA performance results. Tribal programs voluntarily report their GPRA results quarterly and annually for national reporting. GPRA data collected for these three behavioral health measures includes: the number of patients eligible for a screening (denominator), number of eligible patients who receive a screening, (numerator), and the resulting screening rate (percentage).

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: US Public Health Service Act
  

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:
	73 FR 23254	04/29/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 64959	10/31/2008
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Provider Group-Behavioral Health Preventive Care	no form number	Provider Questions
Administrator Group-Behavioral Health Preventive Care	none	none
Data Entry Group- Behavioral Health Preventive Care	none	none

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $200,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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)? No

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: 12/17/2008

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