State of Georgia’s Criminal Justice Coordinating Council’s (CJCC) Evaluation of the Implementation of the (SSI)/SSDI Outreach, Access, and Recovery (SOAR) Model in County Jails

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Addendum - 0960-NEW (Information Collection Tools for the State of Georgias Criminal Justice Coordinating Councils (CJCC) Evaluation of the Implementation of the SSISSDI Outreach, Access.docx	Supplementary Document	Uploaded 2023-07-18	Repair queued
Supporting Statement - 0960-NEW (CJCC) (Final).docx	Supporting Statement A	Uploaded 2023-07-19	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
258843	Informed Consent (Paper)	Other-CJCC Informed Consent Form	New
258842	Follow-up Survey (Internet or Telephone)	Other-CJCC Follow-Up Survey	New
258841	Initial Enrollment Survey (Paper)	Other-CJCC Initial Enrollment Survey	New

ICR Details

OMB Control No: 0960-0833	ICR Reference No: 202303-0960-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: State of Georgia’s Criminal Justice Coordinating Council’s (CJCC) Evaluation of the Implementation of the (SSI)/SSDI Outreach, Access, and Recovery (SOAR) Model in County Jails
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: 10/31/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/19/2023
Terms of Clearance: The agency added a Supporting Statement B. Consistent with the agency's description of this collection, the agency is advised that conclusions from this preliminary qualitative research may not be generalizable.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2026	36 Months From Approved
Responses	360	0	0
Time Burden (Hours)	170	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: Investigators hypothesize that untreated mental illness and repeated psychiatric crises may be a factor in jail recidivism. Connection to SSI/SSDI and attendant insurance benefits may help a person with SPMI obtain treatment and interrupt criminogenic behavior. The intervention will connect respondents in four county jails identified as having SPMI to Medicaid Eligibility Specialists (MES) hired and trained by the Georgia DBHDD, who will help them apply for SSI and SSDI. Investigators hypothesize that untreated mental illness and repeated psychiatric crises may be a factor in jail recidivism. Respondents in two of the four counties (Fulton County Jail and Cobb County Jail) will also have the option of working with a Forensic Peer Mentor (FPM), a formerly incarcerated individual who is familiar with resources that may help participants increase their quality-of-life post incarceration and avoid recidivism.

---

Authorizing Statute(s): US Code: 42 USC 1310 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 19340	03/31/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 41994	06/29/2023
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Follow-up Survey (Internet or Telephone)
Informed Consent (Paper)
Initial Enrollment Survey (Paper)

---

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	360	0	0	360	0	0
Annual Time Burden (Hours)	170	0	0	170	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 data collection that increases the public reporting burden. See chart above for the burden figures. Note: The total burden reflected in ROCIS is 350, while the burden cited in #12 of the Supporting Statement is 113. This discrepancy is because the ROCIS burden reflects the following components: teleservice waiting time . In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

---

Annual Cost to Federal Government: $2,028

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

---

Common Form ICR:  No

---

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: 07/19/2023

---