Implementation of an Internet & Paper-Based Uniform Data Set for OMH-funded Activities

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0990-0275 Supporting Statement B_PIMS-PDS Revision_draft 8.17.16.docx	Supporting Statement B	Uploaded 2016-08-30	Available
19226_ID 0990-0275 2 ASA revised 4-5-13.doc	Supporting Statement A	Uploaded 2013-07-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
10408	OMH Grantee	Other-form	Modified

ICR Details

OMB Control No: 0990-0275	ICR Reference No: 201606-0990-002
Status: Historical Active	Previous ICR Reference No: 201307-0990-007
Agency/Subagency: HHS/HHSDM	Agency Tracking No: 19226
Title: Implementation of an Internet & Paper-Based Uniform Data Set for OMH-funded Activities
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/30/2017
	Date Received in OIRA: 08/30/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2020	36 Months From Approved	01/31/2017
Responses	400	0	400
Time Burden (Hours)	600	0	600
Cost Burden (Dollars)	0	0	0

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Abstract: Involves transitioning the developed paper-based UDS modules to the Web-based prototype and will be implemented among OMH-partners. Will be regular system for reporting program management and performance data for all OMH-funded activities.

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Authorizing Statute(s): PL: Pub.L. 103 - 101 2d Name of Law: 527
  

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:
	81 FR 38191	06/13/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 57593	08/23/2016
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
OMH Grantee

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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	400	400	0	0	0	0
Annual Time Burden (Hours)	600	600	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $326,358

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)? 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: 08/30/2016

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