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
“if unknown, months since LMP" with 2 options, “Approximate” and
“Exact” in the last menstrual period (LMP) field, • rename the
“Current contraceptive use” field to “Contraceptive use” 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.
Form 1 Public Health Investigation Form: Non-TB Illness - Recordkeeping Time
NonSub Change Request - MH Assessment Form and PH Ivest Forms -ROCIS title.docx
Public Health Investigation Form: Non-TB Illness - Recordkeeping Time