Information Collection Request
Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access Program and the Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program
ICR 202302-0906-003 · OMB 0906-0074 · Active
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 4A 2022 PMHCA Program Implementation SSI |
Form and Instruction | New | Available |
| Form 4A 2022 PMHCA Program Implementation SSI |
Form and Instruction | New | Repair queued |
| Form 7A 2022 PMHCA Care Coordinator SSI |
Form and Instruction | New | Available |
| Form 7A 2022 PMHCA Care Coordinator SSI |
Form and Instruction | New | Repair queued |
| Form 6A 2022 PMHCA Champion FGD |
Form and Instruction | New | Available |
| Form 6A 2022 PMHCA Champion FGD |
Form and Instruction | New | Repair queued |
| Form 5A 2022 PMHCA Champion SSI |
Form and Instruction | New | Available |
| Form 5A 2022 PMHCA Champion SSI |
Form and Instruction | New | Repair queued |
| Form 3A 2022 PMHCA Program Implementation Survey |
Form and Instruction | New | Available |
| Form 3A 2022 PMHCA Program Implementation Survey |
Form and Instruction | New | Missing upstream |
| Form 2A 2022 PMHCA Practice- Level Survey |
Form and Instruction | New | Available |
| Form 2A 2022 PMHCA Practice- Level Survey |
Form and Instruction | New | Repair queued |
| Form 1A 2022 PMHCA HP Survey |
Form and Instruction | New | Available |
| Form 1A 2022 PMHCA HP Survey |
Form and Instruction | New | Repair queued |
| Form 2 PMHCA Practice Level Survey |
Form and Instruction | Modified | Available |
| Form 2 PMHCA Practice Level Survey |
Form and Instruction | Modified | Repair queued |
| Form 1 HP Survey 2021 |
Form and Instruction | Unchanged | Available |
| Form 1 HP Survey 2021 |
Form and Instruction | Unchanged | Available |
 Corrected HRSA MCHB 2022 PMHCA Awardee Change Memo OMB Request for Non-Substantive Change.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-02-24 | Repair queued |
| Corrected HRSA MCHB 2022 PMHCA Awardee Change Memo OMB Request for Non-Substantive Change.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-02-24 | Repair queued |
| Supporting Statement A_final.docx |
Supporting Statement A | Uploaded 2022-10-31 | Available |
| Supporting Statement A_final.docx |
Supporting Statement A | Uploaded 2022-10-31 | Missing upstream |
| Supporting Statement B_final.docx |
Supporting Statement B | Uploaded 2022-10-27 | Repair queued |
| Supporting Statement B_final.docx |
Supporting Statement B | Uploaded 2022-10-27 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 258765 |  2022 PMHCA Program Implementation SSI |
Form and Instruction | New | |
| 258765 | 2022 PMHCA Program Implementation SSI |
Form and Instruction | New | |
| 258763 | 2022 PMHCA Care Coordinator SSI |
Form and Instruction | New | |
| 258763 | 2022 PMHCA Care Coordinator SSI |
Form and Instruction | New | |
| 258762 | 2022 PMHCA Champion FGD |
Form and Instruction | New | |
| 258762 | 2022 PMHCA Champion FGD |
Form and Instruction | New | |
| 258761 | 2022 PMHCA Champion SSI |
Form and Instruction | New | |
| 258761 | 2022 PMHCA Champion SSI |
Form and Instruction | New | |
| 258760 | 2022 PMHCA Program Implementation Survey |
Form and Instruction | New | |
| 258760 | 2022 PMHCA Program Implementation Survey |
Form and Instruction | New | |
| 258759 | 2022 PMHCA Practice- Level Survey |
Form and Instruction | New | |
| 258759 | 2022 PMHCA Practice- Level Survey |
Form and Instruction | New | |
| 258756 | 2022 PMHCA HP Survey |
Form and Instruction | New | |
| 258756 | 2022 PMHCA HP Survey |
Form and Instruction | New | |
| 256701 | 2021 PMHCA Program Implementation SSI |
Other-Semi Structured Interview | Unchanged | |
| 256696 | FGD |
Other- | Unchanged | |
| 256695 | 2021 PMHCA Program Implementation Survey |
Other- | Unchanged | |
| 256694 | PMHCA Practice Level Survey |
Form and Instruction | Modified | |
| 256694 | PMHCA Practice Level Survey |
Form and Instruction | Modified | |
| 256687 | HP Survey 2021 |
Form and Instruction | Unchanged | |
| 256687 | HP Survey 2021 |
Form and Instruction | Unchanged | |
| 256686 | 2018/2019 PMHCA/2018 MDRBD Care Coordinator SSI |
Other-Semi Structured Interview | Unchanged | |
| 256685 | 2021 PMHCA Care Coordinator SSI |
Instruction | Unchanged | |
| 256680 | Champion and Community Resources SSI |
Other-Semi Structured Interveiw | Unchanged |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/HRSA |
| OMB Control No | 0906-0074 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202302-0906-002 |
| Date Submitted to OIRA | 2023-02-28 |
| Requested Expiration Date | 1969-12-31 |