Transformation Accountability (TRAC) Reporting System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Attachment 3 Child, Adolescent Tool	Form and Instruction	Removed	Available
Form Attachment 2 Caregiver Tool	Form and Instruction	Removed	Available
Form Attachment 1 Adult Tool	Form and Instruction	Removed	Available
Form Attachment 3 Child, Adolescent Tool	Form and Instruction	Removed	Available
Form Attachment 2 Caregiver Tool	Form and Instruction	Removed	Available
Form Attachment 1 Adult Tool	Form and Instruction	Removed	Available
Form Attachment 3 Child, Adolescent Tool	Form and Instruction	Removed	Available
Form Attachment 2 Caregiver Tool	Form and Instruction	Removed	Available
Form Attachment 1 Adult Tool	Form and Instruction	Removed	Available
Form Attachment 3 Child, Adolescent Tool	Form and Instruction	Removed	Available
Form Attachment 2 Caregiver Tool	Form and Instruction	Removed	Available
Form Attachment 1 Adult Tool	Form and Instruction	Removed	Available
Form Attachment 3 Child, Adolescent Tool	Form and Instruction	Removed	Available
Form Attachment 1 Adult Tool	Form and Instruction	Removed	Available
Form Attachment 2 Caregiver Tool	Form and Instruction	Removed	Available
Form Attachment 3 Child, Adolescent Tool	Form and Instruction	Removed	Available
Form Attachment 2 Caregiver Tool	Form and Instruction	Removed	Available
Form Attachment 1 Adult Tool	Form and Instruction	Removed	Available
Form Client-Level Instr Client-Level Instruments	Form and Instruction	Modified	Repair queued
TRAC_OMB_Supporting_Statement Final Revised 3-24-10.doc	Supporting Statement B	Uploaded 2010-03-24	Available
Attach4b-Consumer Screens - Child NOMS Final.ppt	Supplementary Document	Uploaded 2006-12-15	Available
Attach4a-Consumer Screens - Adult NOMS Final.ppt	Supplementary Document	Uploaded 2006-12-15	Available
Attach4b-Consumer Screens - Child NOMS Final.ppt	Supplementary Document	Uploaded 2006-12-15	Available
Attach4a-Consumer Screens - Adult NOMS Final.ppt	Supplementary Document	Uploaded 2006-12-15	Available
Attach4b-Consumer Screens - Child NOMS Final.ppt	Supplementary Document	Uploaded 2006-12-15	Repair queued
Attach4a-Consumer Screens - Adult NOMS Final.ppt	Supplementary Document	Uploaded 2006-12-15	Available
Attach4b-Consumer Screens - Child NOMS Final.ppt	Supplementary Document	Uploaded 2006-12-15	Available
Attach4a-Consumer Screens - Adult NOMS Final.ppt	Supplementary Document	Uploaded 2006-12-15	Available
Attach4b-Consumer Screens - Child NOMS Final.ppt	Supplementary Document	Uploaded 2006-12-15	Available
Attach4a-Consumer Screens - Adult NOMS Final.ppt	Supplementary Document	Uploaded 2006-12-15	Available
Attach4b-Consumer Screens - Child NOMS Final.ppt	Supplementary Document	Uploaded 2006-12-15	Available
Attach4a-Consumer Screens - Adult NOMS Final.ppt	Supplementary Document	Uploaded 2006-12-15	Available
Att6. Westat IRB Exemption.doc	Supplementary Document	Uploaded 2010-03-25	Available
Att5. Public Comments in Response to Fed Reg Not.pdf	Supplementary Document	Uploaded 2010-03-25	Available
TRAC_OMB_Supporting_Statement Final Revised 3-24-10.doc	Supporting Statement A	Uploaded 2010-03-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
46638	CMHS NOMs	Form and Instruction	Removed	Child, Adolescent Tool
46638	CMHS NOMs	Form and Instruction	Removed	Caregiver Tool
46638	CMHS NOMs	Form and Instruction	Removed	Adult Tool
46637	CMHS NOMs	Form and Instruction	Removed	Child, Adolescent Tool
46637	CMHS NOMs	Form and Instruction	Removed	Caregiver Tool
46637	CMHS NOMs	Form and Instruction	Removed	Adult Tool
46636	CMHS NOMs	Form and Instruction	Removed	Child, Adolescent Tool
46636	CMHS NOMs	Form and Instruction	Removed	Caregiver Tool
46636	CMHS NOMs	Form and Instruction	Removed	Adult Tool
46635	CMHS NOMs	Form and Instruction	Removed	Child, Adolescent Tool
46635	CMHS NOMs	Form and Instruction	Removed	Caregiver Tool
46635	CMHS NOMs	Form and Instruction	Removed	Adult Tool
46634	CMHS NOMs	Form and Instruction	Removed	Child, Adolescent Tool
46634	CMHS NOMs	Form and Instruction	Removed	Adult Tool
46634	CMHS NOMs	Form and Instruction	Removed	Caregiver Tool
46633	CMHS NOMs	Form and Instruction	Removed	Child, Adolescent Tool
46633	CMHS NOMs	Form and Instruction	Removed	Caregiver Tool
46633	CMHS NOMs	Form and Instruction	Removed	Adult Tool
46632	Client-Level	Form and Instruction	Modified	Client-Level Instruments
192393	Infrastructure, Development, Prevention MH Abstraction	Instruction	New

ICR Details

OMB Control No: 0930-0285	ICR Reference No: 201003-0930-005
Status: Historical Active	Previous ICR Reference No: 200701-0930-001
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Transformation Accountability (TRAC) Reporting System
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: 05/06/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/30/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2013	36 Months From Approved	05/31/2010
Responses	19,449	0	60,081
Time Burden (Hours)	26,993	0	14,293
Cost Burden (Dollars)	0	0	0

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Abstract: This data activity is to provide a level of consistency with the NOMs domain in SAMHSA-wide data collection and reporting of performance measures across all of its Centers and programs. This particular activity will promote the use of consistent measures among CMHS programs, grantees and contractors funded through the Programs of Regional and National Significance (PRNS) and the Children Mental Health Initiative (CMHI) budget lines. The Consumer NOMs recommended by CMHS are a result of extensive examination and recommendations, by panels of staff, experts, and grantees. Wherever feasible, the proposed measures are consistent with or build upon previous data development efforts within CMHS.

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Authorizing Statute(s): EO: EO 1115 Name/Subject of EO: GPRA
  

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 51280	10/06/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 14161	03/24/2010
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
CMHS NOMs	Attachment 1, Attachment 2, Attachment 3	Adult Tool ,   Caregiver Tool ,   Child, Adolescent Tool
CMHS NOMs	Attachment 1, Attachment 2, Attachment 3	Adult Tool ,   Caregiver Tool ,   Child, Adolescent Tool
CMHS NOMs	Attachment 1, Attachment 2, Attachment 3	Adult Tool ,   Caregiver Tool ,   Child, Adolescent Tool
CMHS NOMs	Attachment 3, Attachment 1, Attachment 2	Adult Tool ,   Caregiver Tool ,   Child, Adolescent Tool
CMHS NOMs	Attachment 1, Attachment 2, Attachment 3	Adult Tool ,   Caregiver Tool ,   Child, Adolescent Tool
CMHS NOMs	Attachment 1, Attachment 2, Attachment 3	Adult Tool ,   Caregiver Tool ,   Child, Adolescent Tool
Client-Level	Client-Level Instruments	Client-Level Instruments
Infrastructure, Development, Prevention MH Abstraction

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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	19,449	60,081	0	-40,632	0	0
Annual Time Burden (Hours)	26,993	14,293	0	12,700	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: Currently there are 14,293 burden hours in the OMB inventory. CMHS is now requesting 26,992 hours. This increase of 12,699 hours is due to a program change.

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Annual Cost to Federal Government: $8,807,858

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: 03/30/2010

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