Primary and Behavioral Health Care Integration Program

Forms and Documents

Document Name	Status
Form Quarterly Report Grantee - Quarterly Reports Form and Instruction	Modified
Form Physical Health In Client-level interview-Physical Health Indicators Form and Instruction	Removed
PBHCI-SS-A-10-6-2015.doc Supporting Statement A	2015-10-06
PBHCI-SS-B-3 25 15.doc Supporting Statement B	2015-06-18

IC Document Collections

IC ID	Document Title	Status
196137	Grantee - Quarterly Reports Form and Instruction	Modified
196135	Client-level interview-Physical Health Indicators Form and Instruction	Removed

ICR Details

OMB Control No: 0930-0340	ICR Reference No: 201506-0930-002
Status: Historical Active	Previous ICR Reference No: 201408-0930-003
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Primary and Behavioral Health Care Integration 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: 10/14/2015
	Date Received in OIRA: 06/18/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2018	36 Months From Approved	10/31/2017
Responses	688	0	28,280
Time Burden (Hours)	1,376	0	2,800
Cost Burden (Dollars)	0	0	0

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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.

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Authorizing Statute(s): US Code: 42 USC 505 Name of Law: Data Collection
  

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:
	80 FR 19675	04/13/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 34446	06/16/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Grantee - Quarterly Reports	Quarterly Report	Quarterly Report
Client-level interview-Physical Health Indicators	Physical Health Indicators	Physical Health Indicators

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ICR Summary 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	688	28,280	0	-27,592	0	0
Annual Time Burden (Hours)	1,376	2,800	0	-1,424	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 2,800 burden hours in the OMB inventory. SAMHSA/CMHS is requesting 1,376 hours. The program change of a decrease of 1,424 hours is due to the following: the deletion of the physical health indicators (a reduction of -2,240 hours, -28,000 responses) and the increased burden associated with the additional 102 grantees completing quarterly reports (an increase of 816 hours, 408 responses).

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Annual Cost to Federal Government: $68,000

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

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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: 06/18/2015

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