Area Health Education Centers Project on the Mental and Behavioral Health and Substance Abuse Issues of Veterans/Service Members and Their Families

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 2 CE Evaluation Follow-up Form	Form and Instruction	New	Available
Form 1 CE Evaluation Results Form	Form and Instruction	New	Available
REVISED Supporting Statement Section B.docx	Supporting Statement B	Uploaded 2012-07-10	Available
REVISED Supporting Statement Section A.docx	Supporting Statement A	Uploaded 2012-07-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
201384	CE Evaluation Follow-up Form	Form and Instruction	New	CE Evaluation Follow-up Form
201383	CE Evaluation Resuts Form	Form and Instruction	New	CE Evaluation Results Form

ICR Details

OMB Control No: 0915-0352	ICR Reference No: 201203-0915-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Area Health Education Centers Project on the Mental and Behavioral Health and Substance Abuse Issues of Veterans/Service Members and Their Families
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: 07/16/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/02/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2015	36 Months From Approved
Responses	12,000	0	0
Time Burden (Hours)	5,340	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This project will evaluate whether or not providers change their practice after receiving continuing education. Trained AHEC staff will provide continuing education (CE) for civilian primary care, mental and behavioral health, and other healthcare providers to improve the quality and cultural competency of the care they offer to veterans/service members and their families and will conduct an evaluation of those offerings. Two instruments will be used in the evaluation, including the CE evaluation results form and the CE evaluation follow-up form. These instruments will provide aggregate information about the providers trained and project activities and will assess through a follow-up survey whether a provider changed their practice after receiving the CE offering.

---

Authorizing Statute(s): US Code: 42 USC 294a Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 148 5403 Name of Law: Patient Protection and Affordable Care Act of 2010
  

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:
	76 FR 81514	12/28/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 12315	02/29/2012
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
CE Evaluation Follow-up Form	2	CE Evaluation Follow-up Form
CE Evaluation Resuts Form	1, 1	CE Evaluation Results Form

---

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	12,000	0	0	12,000	0	0
Annual Time Burden (Hours)	5,340	0	0	5,340	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 collection that requires a total annual burden of 5,340 hours.

---

Annual Cost to Federal Government: $112,385

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]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 03/02/2012

---