National Evaluation of the Comprehensive Mental Health Services for Children and Their Families Program: Phase V

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Instruments Nat'll Eval. of the Comprehensive MH Services for Children and Their Families Program - Caregivers	Form and Instruction	Modified	Available
Form Instruments Nat'll Eval. of the Comprehensive MH Services for Children and Their Families Program - Community Staff	Form and Instruction	New	Available
Form Instruments Nat'll Eval. of the Comprehensive MH Services for Children and Their Families Program - Youth	Form and Instruction	New	Available
CMHI Phase V OMB Re-Submission-8-5-09.doc	Supporting Statement B	Uploaded 2009-08-05	Available
CMHI Phase V OMB Re-Submission_ATTACHMENTS.zip	Supplementary Document	Uploaded 2009-08-05	Available
CMHI Phase V OMB Re-Submission_ATTACHMENTS.zip	Supplementary Document	Uploaded 2009-08-05	Available
CMHI Phase V OMB Re-Submission_ATTACHMENTS.zip	Supplementary Document	Uploaded 2009-08-05	Repair queued
CMHI Phase V OMB Re-Submission-8-5-09.doc	Supporting Statement A	Uploaded 2009-08-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43646	Nat'll Eval. of the Comprehensive MH Services for Children and Their Families Program - Caregivers	Form and Instruction	Modified
190262	Nat'll Eval. of the Comprehensive MH Services for Children and Their Families Program - Community Staff	Form and Instruction	New
190261	Nat'll Eval. of the Comprehensive MH Services for Children and Their Families Program - Youth	Form and Instruction	New

ICR Details

OMB Control No: 0930-0280	ICR Reference No: 200908-0930-002
Status: Historical Active	Previous ICR Reference No: 200703-0930-002
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: National Evaluation of the Comprehensive Mental Health Services for Children and Their Families Program: Phase V
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/06/2009
	Date Received in OIRA: 08/10/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2012	36 Months From Approved	11/30/2009
Responses	32,679	0	27
Time Burden (Hours)	39,527	0	27,936
Cost Burden (Dollars)	0	0	0

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Abstract: The Comunity Mental Health Servies Program for Children with Serious Emotional Distrubances supports a broad array of community-based and family-centered services delivered through the system of care model. Most data collection instruments and procedures are built upon those used in the evaluation of Phase IV grantees

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Authorizing Statute(s): US Code: 5 USC 520 Name of Law: CMHS
  

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:
	74 FR 15730	04/07/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 38202	07/31/2009
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
Nat'll Eval. of the Comprehensive MH Services for Children and Their Families Program - Caregivers	Instruments	Instruments
Nat'll Eval. of the Comprehensive MH Services for Children and Their Families Program - Youth	Instruments	Instruments
Nat'll Eval. of the Comprehensive MH Services for Children and Their Families Program - Community Staff	Instruments	Instruments

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ICR Summary of Burden

table that charts list 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	32,679	27	0	32,652	0	0
Annual Time Burden (Hours)	39,527	27,936	0	11,591	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There are 27,936 burden hours in the original OMB approval. CMHS is now requesting 39,527 hours. This is an increase of 11,591 hours due to program changes.

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Annual Cost to Federal Government: $3,846,036

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)? 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: 08/10/2009

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