Pre-Test of Instruments of Psychosocial Care for the Treatment of Adults with PTSD

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
20987 ID_PTSD ASPE PRA Supporting Statement B_rev 2-26-14.docx	Supporting Statement B	Uploaded 2014-03-12	Available
20987 ID_Supplemental Document-Email to Clinician from Site Coordinator-ATTACHMENT 11.docx	Supplementary Document	Uploaded 2014-03-12	Available
20987 ID_Supplemental Document-Consumer Background-ATTACHMENT 8.docx	Supplementary Document	Uploaded 2014-03-12	Available
20987 ID_Supplemental Document-Supporting Statement Part A References-ATTACHMENT 12.docx	Supplementary Document	Uploaded 2014-03-12	Available
20987 ID_Supplemental Document-Supporting Statement Part B References-ATTACHMENT 13.docx	Supplementary Document	Uploaded 2014-03-12	Available
20987 ID_PTSD ASPE PRA Supporting Statement A rev 2-4-14.docx	Supporting Statement A	Uploaded 2014-02-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210716	Site Coordinator (sampling)	Other-sampling	New
210715	Site Coordinator (checklist)	Other-survey	New
210714	Consumer	Other-survey	New
210713	Clinician Supervisor (survey)	Other-survey	New
210712	Clinician (clinician survey)	Other-survey	New
210711	Clinician Supervisor(demongraphics questionnaire)	Other-questionnare	New
210710	Clinician(demographics questionnaire)	Other-questionnaire	New

ICR Details

OMB Control No: 0990-0418	ICR Reference No: 201403-0990-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No: 20987
Title: Pre-Test of Instruments of Psychosocial Care for the Treatment of Adults with PTSD
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 without change	Conclusion Date: 05/22/2014
	Date Received in OIRA: 03/13/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2017	36 Months From Approved
Responses	378	0	0
Time Burden (Hours)	73	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: ASPE supports HHS in its effort "to enhance the health and well-being of Americans by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services." These advances include treatments for behavioral health conditions. In particular, "improving health care quality and patient safety" through wider dissemination of effective mental health treatment such as evidence-based psychotherapy is an HHS priority.

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Authorizing Statute(s): None

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:
	78 FR 70948	11/27/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 14042	03/12/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
Clinician(demographics questionnaire)
Clinician Supervisor(demongraphics questionnaire)
Clinician (clinician survey)
Clinician Supervisor (survey)
Consumer
Site Coordinator (checklist)
Site Coordinator (sampling)

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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	378	0	0	378	0	0
Annual Time Burden (Hours)	73	0	0	73	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: New collection

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Annual Cost to Federal Government: $190,719

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]? No

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

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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: 03/13/2014

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