Interviews with Grantees Integrating Behavioral Health Treatment, Prevention, and HIV Medical Care Services

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Follow Up Intervie Follow Up Interview Guide	Form and Instruction	Modified	Available
Form Baseline Interview Baseline Interview Guide	Form and Instruction	Modified	Available
SAMHSA MAI COC OMB SS B 8.10.16.doc	Supporting Statement B	Uploaded 2016-08-10	Available
SAMHSA MAI COC OMB SS A 8.10.16.doc	Supporting Statement A	Uploaded 2016-08-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
205169	Follow Up Interview Guide	Form and Instruction	Modified
205168	Baseline Interview Guide	Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0336	ICR Reference No: 201608-0930-001
Status: Historical Active	Previous ICR Reference No: 201212-0930-002
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Interviews with Grantees Integrating Behavioral Health Treatment, Prevention, and HIV Medical Care Services
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/21/2016
	Date Received in OIRA: 08/17/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2019	36 Months From Approved
Responses	612	0	0
Time Burden (Hours)	918	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The goal of the MAI-CoC project is to integrate behavioral health treatment, prevention, and HIV and hepatitis medical care services for racial/ethnic minority populations at high risk for behavioral health disorders who are also at high risk for or living with HIV and hepatitis. The program is primarily intended for substance use disorder treatment and community mental health providers to provide coordinated and integrated services through the collocation and/ or integration of behavioral health treatment and HIV and hepatitis medical care. Interviews conducted with MAI-CoC grantees during initial and follow-up site visits are an integral part of evaluation efforts to: (1) Assess the impact of the SAMHSA-funded HIV and hepatitis programs in: reducing behavioral health disorders and HIV and hepatitis infections; increasing access to substance use disorder and mental disorder treatment and care; improving behavioral health outcomes; and reducing HIV and hepatitis-related disparities; (2) Describe the different integrated behavioral health and medical program models; and (3) Determine which program types or models are most effective in improving behavioral health and clinical outcomes.

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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:
	81 FR 36939	06/08/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 53495	08/12/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Baseline Interview Guide	Baseline Interview Guide	Baseline Interview Guide
Follow Up Interview Guide	Follow Up Interview Guide	Follow Up Interview Guide

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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	612	0	0	612	0	0
Annual Time Burden (Hours)	918	0	0	918	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: Currently there are 156 total burden hours in the OMB inventory. SAMHSA is requesting 918 hours. This program change of an increase of 762 hours is due to the implementation of the revised interview guides for conducting two rounds of interviews with grantees (Initial and Follow-up) over two years.

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Annual Cost to Federal Government: $134,813

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

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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: 08/17/2016

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