Immediate Disaster Case Management Intake Assessment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 IDCM Intake Assessment	Form and Instruction	New	Available
Emer. Req. memo to OIRA 6-5-15.pdf	Supplementary Document	Uploaded 2015-06-23	Available
Emergency Review Request with Comments_OMB Supporting Statement_OHSEPR_ECMRS_SUBMITTED_v2 20150626 (OMB-0970-NEW).doc	Supporting Statement A	Uploaded 2015-06-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
216998	IDCM Intake Assessment	Form and Instruction	New

ICR Details

OMB Control No: 0970-0461	ICR Reference No: 201506-0970-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No: OHSEPR
Title: Immediate Disaster Case Management Intake Assessment
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 06/19/2015
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/09/2015
	Date Received in OIRA: 06/11/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2016	6 Months From Approved
Responses	3,500	0	0
Time Burden (Hours)	2,333	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Office of Human Services Emergency Preparedness and Response (OHSEPR), within the Administration for Children and Families (ACF) seeks to improve the collection and storage of client data and optimize transfer of case files to State, Tribal, or Territorial partners upon Immediate Disaster Case Management (IDCM) program closure. The information collection will serve to optimize services delivered to individuals and households impacted by a disaster. In addition, it will better support State/Tribal/Territorial and Federal planning for disaster survivors' human service needs.

Emergency Justfication: DEPARTMENT OF HEALTH&. HUMAN SERVICES June 5, 2015 To: Josh Brammer Office of Information and Regulatory Affairs From: Robert Sargis ACF Reports Clearance Officer ADMINISTRATION FOR CHILDREN AND FAMILIES Office of the Assistant Secretary, Suite 600 370 L'Enfant Promenade, S.W. Washington, D.C. 20447 Subject: Emergency Justification for Administration for Children and Families (ACF), Office of Human Services Emergency Preparedness and Response (OHSEPR) to execute the IDCM program The widespread flooding and deadly storms in Texas, Oklahoma, and Arkansas has caused the President to approve Major Disaster Declarations in Texas and Oklahoma. Currently Individual Assistance (lA) has been approved for three counties in Texas and Oklahoma. Damage assessments are currently in progress and more counties may be approved for lA. The Administration for Children and Families (ACF), Office of Human Services Emergency Preparedness and Response (OHSEPR) has an immediate need to prepare for information collection in support of the Immediate Disaster Case Management (IDCM) mission. This effort comes under the federal Disaster Case Management Program (DCMP), which is operated by the Federal Emergency Management Agency (FEMA). ACF's IDCM service will be activated to execute the IDCM mission, if selected by FEMA following a Presidential declaration of a disaster where lA has been approved. IDCM services can help connect individuals with disaster-caused unmet needs with resources and services of multiple agencies. The primary purpose of the information collection pertains to ACF/OHSEPR's goal to quickly identify critical gaps, resources, needs, and service to support State, local and non-profit capacity for disaster case management and to augment and build capacity where none exist. Based on the above, public harm is reasonably likely to result as a result of this unanticipated event, ACF requests to use procedures for emergency processing at Sec. 1320.13 of the PRA Implementing regulation. ACF requests approval by June 19, 2015.

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Authorizing Statute(s): US Code: 42 USC 5189d Name of Law: Robert T. Stafford Disaster Relief and Emergency Assistance Act
  

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

Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
IDCM Intake Assessment	1	OHSEPR IDCM Intake Assessment

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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	3,500	0	0	3,500	0	0
Annual Time Burden (Hours)	2,333	0	0	2,333	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 an emergency request for a new collection.

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Annual Cost to Federal Government: $143,742

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]? 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: 06/11/2015

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