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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Provider-Administr Providers/Administrators	Form and Instruction	Modified	Available
Form Youth Youth	Form and Instruction	Modified	Available
Form Caregiver Caregivers	Form and Instruction	Modified	Available
Consultation.pdf	Supplementary Document	Uploaded 2015-03-25	Available
Phase VI SS Part B_6-8-15 Final.docx	Supporting Statement B	Uploaded 2015-06-08	Available
Phase VI SS Part A_6-8-15 Final.docx	Supporting Statement A	Uploaded 2015-06-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
190422	Providers/Administrators	Form and Instruction	Modified
190421	Youth	Form and Instruction	Modified
190420	Caregivers	Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0307	ICR Reference No: 201503-0930-003
Status: Historical Active	Previous ICR Reference No: 201206-0930-002
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: National Evaluation of the Comprehensive Mental Health Services for Children and Their Families Program: Phase VI
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: 06/08/2015
	Date Received in OIRA: 03/26/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2018	36 Months From Approved	09/30/2015
Responses	68,997	0	232,582
Time Burden (Hours)	13,074	0	40,024
Cost Burden (Dollars)	0	0	0

---

Abstract: The Community 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 VI grantees.

---

Authorizing Statute(s): US Code: 42 USC 565 Name of Law: Evaluations
  

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:
	80 FR 2953	01/21/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 15622	03/24/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Caregivers	Caregiver	Caregiver
Youth	Youth	Youth
Providers/Administrators	Provider-Administrator	Provider-Administrator

---

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	68,997	232,582	0	-163,585	0	0
Annual Time Burden (Hours)	13,074	40,024	0	-26,950	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Currently there are 40,024 hours in the OMB inventory. SAMHSA is requesting 13,074 hours for this submission. This revision is due to a decrease of 26,960 hours is due to program changes resulting from the closing of 19 communities funded in FY 2009 that no longer require data collection and data collection for the Sector and Comparison Study.

---

Annual Cost to Federal Government: $9,168,221

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

---

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: 03/26/2015

---