The Mental Health Assessment Form was approved by OMB on September 16, 2023, as part of the Mental Health Asessment Form, Public Health Investigation Form: Active TB, and Public Health Investigation Form: Non-TB Illness Form information collection. The purpose of the Mental Health Assessment is to collect standardized health information on unaccompanied children during evaluations with mental health providers.
In November 2023, ORR hired a Reproductive Health specialist who reviewed the Mental Health Assessment Form and recommended changes to the reproductive health history section. ORR believes these changes will aid mental health providers in performing a thorough assessment and creating an informed healthcare plan.
ORR would like to:
⢠replace the field âif unknown, months since LMP" with 2 options, âApproximateâ and âExactâ in the last menstrual period (LMP) field,
⢠rename the âCurrent contraceptive useâ field to âContraceptive useâ and add a specify field with examples,
US Code:
6 USC 279
Name of Law: Flores Settlement Agreement
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:
(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;
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.
Public Health Investigation Form: Non-TB Illness - Recordkeeping Time