Evaluation of SAMHSA Primary Care Behavioral Health Integration Grant Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
OMB Supporting Statment Part B 9 23 11_V3.docx	Supporting Statement B	Uploaded 2011-09-25	Available
OMB Supporting Statement Part A Full Pkg 9 23 11_V4.docx	Supporting Statement A	Uploaded 2011-09-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
198670	Grantee Key Staff- Web Survey	Other-survey	New
198669	SMI Clients- Clients Exam and Survey-Follow-up	Other-form	New
196137	Grantee Project Directors- Quarterly Reports	Other-form	Modified
196136	Grantee Data - Individual Service Utilization Data	Other-survey	Modified
196135	Grantee Data Staff -TRAC Indicators	Other-surve	Modified
196134	Control Site leadership - Site visit Interview	Other-survey	Modified
196133	Care coordinators interivew	Other-survey	Modified
196132	MH Provider Interview	Other-survey	Modified
196131	Grantee PH Providers- Site Visit Interview	Other-survey	Modified
196130	Grantee Leadership (Sites Visit Interview)	Other-interview	Modified
196129	SMI Clients -Client Exam and Survey-Baseline	Other-survey	Modified

ICR Details

OMB Control No: 0930-0340	ICR Reference No: 201404-0930-001
Status: Historical Active	Previous ICR Reference No: 201102-0990-002
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Evaluation of SAMHSA Primary Care Behavioral Health Integration Grant Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/03/2014
	Date Received in OIRA: 04/03/2014
Terms of Clearance: HHS will endeavor to administer the web-survey to all intervention sites before interviews commence. HHS will standardize its client selection and interview processes. HHS will not attempt to generalize the results of its outcome data unless statistically justified.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2014	36 Months From Approved
Responses	59,865	0	13,440
Time Burden (Hours)	10,057	0	4,211
Cost Burden (Dollars)	0	0	0

---

Abstract: SAMHSA's PBHCI grantees have been developing and implementing an array of integrated services designed to improve the physical and behavioral health status of people with serious mental illnesses, including individuals with co-occurring substance use disorders. These services incorporate a prevention and wellness approach and are provided using different models of cooperation and collaboration between community behavioral health and primary care.

---

Authorizing Statute(s): US Code: 38 USC 527 Name of Law: Evaluation and Data Collection
   PL: Pub.L. 103 - 62 527 Name of Law: Government Performance and Results Act
  

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 17127	03/28/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 40912	07/12/2011
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 11

table that charts list of burden

IC Title	Form No.	Form Name
SMI Clients- Clients Exam and Survey-Follow-up
Grantee Key Staff- Web Survey
SMI Clients -Client Exam and Survey-Baseline
Grantee Leadership (Sites Visit Interview)
Grantee PH Providers- Site Visit Interview
MH Provider Interview
Care coordinators interivew
Control Site leadership - Site visit Interview
Grantee Data Staff -TRAC Indicators
Grantee Data - Individual Service Utilization Data
Grantee Project Directors- Quarterly Reports

---

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	59,865	13,440	0	46,425	0	0
Annual Time Burden (Hours)	10,057	4,211	0	5,846	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 has been one change in the evaluation plan since the submission of the Emergency 6 Month Package. This change is the inclusion of the web-based survey in year 3 of the evaluation. For this reason, and the fact that this submission represents the average annual burden over 3 years, the annual burden hours and costs are greater in this submission than the previous one. Years two and three have greater burden and cost compared to year one of the study due to the inclusion of more client exams/surveys, site visits, and the web survey. An additional change is the reduction in the total number of grantees from an estimate of 60 in the earlier submission to the actual number of 56 grantees.

---

Annual Cost to Federal Government: $242,961

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]? 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)? Yes

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: 07/27/2011

---