Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access and Screening and Treatment for Maternal Depression and Related Behavioral Disorders Programs Project

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4-1 Program Implmentation Semi-Structured Interview	Form and Instruction	New	Available
Form 3-1 Program Implementation Survey	Form and Instruction	New	Available
Form 2-1 Practice-Level Survey	Form and Instruction	New	Available
Form 1-1 Health Care Provider Survey	Form and Instruction	New	Available
Supporting Statement A_clean_5-13-2020.docx	Supporting Statement A	Uploaded 2020-05-20	Available
Attachment B16 - MDRBD Program SSI Guide_Pilot Test Results 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment B15 - PMHCA Program SSI Guide_Pilot Test Results 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment B14 - MDRBD Program Implementation Survey_Pilot Test Results 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment B13 - PMHCA Program Implementation Survey_Pilot Test Results 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment B12 - MDRBD Program Practice-level Survey_Pilot Test Results 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment B11 - PMHCA Program Practice-level Survey_Pilot Test Results 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment B10 - MDRBD Program HCP Survey_Pilot Test Results 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment B9 - PMHCA Program HCP Survey_Pilot Test Results 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A37 - MDRBD SSI Followup Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A36 - PMHCA SSI Followup Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A35-MDRBD Program Implementation Survey Followup Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A34-PMHCA Program Implementation Survey Followup Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A33 - MDRBD Practice Survey Followup Email From Program 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A32 - PMHCA Practice Survey Followup Email From Program 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Repair queued
Attachment A31 - MDRBD HCP Survey Followup Email From Program 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A30 - PMHCA HCP Survey Followup Email From Program 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A29 - MDRBD Practice Survey Followup Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A28 - PMHCA Practice Survey Followup Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A27 - MDRBD HCP Survey Followup Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A26 - PMHCA HCP Survey Followup Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A25 - MDRBD SSI Participation Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A24 - PMHCA SSI Participation Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A23-MDRBD Program Implementation Survey Participation Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A22-PMHCA Program Implementation Survey Participation Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A21 - MDRBD Practice Survey Participation Email From Program 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A20 - PMHCA Practice Survey Participation Email From Program 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A19 - MDRBD HCP Survey Participation Email From Program 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A18 - PMHCA HCP Survey Participation Email From Program 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A17 - MDRBD Practice Survey Participation Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A16 - PMHCA Practice Survey Participation Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A15 - MDRBD HCP Survey Participation Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A14 - PMHCA HCP Survey Participation Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A13 - MDRBD SSI Notification Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A12 - PMHCA SSI Notification Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A11-MDRBD Program Implementation Survey Notification Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A10-PMHCA Program Implementation Survey Notification Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A9 - MDRBD Practice Survey Notification Email From Program 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A8 - PMHCA Practice Survey Notification Email From Program 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A7 - MDRBD HCP Survey Notification Email From Program 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A6 - PMHCA HCP Survey Notification Email From Program 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A5 - MDRBD Practice Survey Notification Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A4 - PMHCA Practice Survey Notification Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A3 - MDRBD HCP Survey Notification Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A2 - PMHCA HCP Survey Notification Email From JBS 12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Evaluation Question_Data Collection Tool Mapping_12-13-19.docx	Supplementary Document	Uploaded 2020-02-06	Available
Program Evaluation for Pediatric Mental Healthcare Access Program and Maternal Depression 12-13-19 sh.pdf	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A38 - IRB Exempt Approval Letter.pdf	Supplementary Document	Uploaded 2020-02-06	Available
Attachment A1 - FRN 60-Day Publication.pdf	Supplementary Document	Uploaded 2020-02-06	Available
Supporting Statement B_12-13-19.docx	Supporting Statement B	Uploaded 2020-02-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
239854	Program Implmentation Semi-Structured Interview	Form and Instruction	New
239853	Program Implementation Survey	Form and Instruction	New
239852	Practice-Level Survey	Form and Instruction	New
239850	Health Care Provider Survey	Form and Instruction	New

ICR Details

OMB Control No: 0906-0052	ICR Reference No: 202002-0906-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access and Screening and Treatment for Maternal Depression and Related Behavioral Disorders Programs Project
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/04/2020
	Date Received in OIRA: 02/07/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2023	36 Months From Approved
Responses	51,712	0	0
Time Burden (Hours)	9,828	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this project is to design and implement an evaluation of HRSA’s MCHB PMHCA Program and MDRBD Program. Activities for this project include preparing and submitting the OMB package, preparing data collection tools, administering the data collection tools, analyzing data, and disseminating findings. Respondents will include health care providers and practices as well as awardee project directors/principal investigators.

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Authorizing Statute(s): PL: Pub.L. 114 - 255 10005 Name of Law: 21st Century Cures Act (Screening and treatment for maternal depression)
   PL: Pub.L. 114 - 255 10002 Name of Law: 21st Century Cures Act (Increasing access to pediatric mental health care)
  

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:
	84 FR 55579	10/17/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 3059	01/17/2020
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Health Care Provider Survey	1-1, 1-1 Tracked, 1-2, 1-2 Tracked	Attachment B1 - PMHCA Health Care Provider Survey_clean_4-29-2020.docx ,   Attachment B1 - PMHCA Health Care Provider Survey_tracked_4-29-2020.docx ,   Attachment B2-MDRBD Health Care Provider Survey_clean_4-29-2020.docx ,   Attachment B2-MDRBD Health Care Provider Survey_tracked_4-29-2020.docx
Practice-Level Survey	2-1, 2-2	PMHCA Practice Level Survey_2-3-2020.docx ,   MDRBD Practice Level Survey 2-3-2020.docx
Program Implementation Survey	3-1, 3-2	PMHCA Program Implementation Survey_2-3-2020.docx ,   MDRBD Program Implementation Survey_2-3-2020.docx
Program Implmentation Semi-Structured Interview	4-1, 4-2	PMHCA Program Implementation SSI Guide_2-3-2020.docx ,   MDRBD Program Implementation SSI Guide_2-3-2020.docx

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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	51,712	0	0	51,712	0	0
Annual Time Burden (Hours)	9,828	0	0	9,828	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 a new ICR, so burden is increasing from zero (0).

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Annual Cost to Federal Government: $491,363

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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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: 02/07/2020

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