Pediatric Mental Health Care Access Program National Impact Study

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Health Professional Impact Survey	Form and Instruction	New	Available
Form 1 Health Professional Impact Survey	Form and Instruction	New	Repair queued
Form 2 Family-Caregiver Focus Group Discussion	Form and Instruction	New	Available
Form 2 Family/Caregiver Focus Group Discussion	Form and Instruction	New	Repair queued
Form 3 Family-Caregiver Demographic Questionanaire	Form and Instruction	New	Repair queued
Form 3 Family/Caregiver Demographic Questionnaire	Form and Instruction	New	Repair queued
Attachment B7 - Family-Caregiver Pilot Feedback_Final.docx	Supplementary Document	Uploaded 2024-04-30	Repair queued
Attachment B6 - HP Impact Survey Pilot Feedback_Final.docx	Supplementary Document	Uploaded 2024-04-30	Repair queued
Attachment A12 - IRB Decision Letter.pdf	Supplementary Document	Uploaded 2024-04-30	Repair queued
Attachment A11 - PMHCA FGD Flyer_Final.pdf	Supplementary Document	Uploaded 2024-04-30	Repair queued
Attachment A10 - PMHCA FGD Overview Guide_Final.docx	Supplementary Document	Uploaded 2024-04-30	Repair queued
Attachment A9 - PMHCA FGD Recruitment Procedures_Final.docx	Supplementary Document	Uploaded 2024-04-30	Repair queued
Attachment A8 - PMHCA FGD Recruiter Email From JBS_Final.docx	Supplementary Document	Uploaded 2024-04-30	Repair queued
Attachment A7 - PMHCA HP Survey Reminder Email From Program_Final.docx	Supplementary Document	Uploaded 2024-04-30	Repair queued
Attachment A6 - PMHCA HP Survey Participation Email From Program_Final.docx	Supplementary Document	Uploaded 2024-04-30	Repair queued
Attachment A5 - PMHCA HP Survey Reminder Email From JBS_Final.docx	Supplementary Document	Uploaded 2024-04-30	Repair queued
Attachment A4 - PMHCA HP Survey Participation Email From JBS_Final.docx	Supplementary Document	Uploaded 2024-04-30	Repair queued
Attachment A1 - Legislation_Final.docx	Supplementary Document	Uploaded 2024-04-30	Repair queued
Attachment A2 - 60-day FRN Publication_Final.pdf	Supplementary Document	Uploaded 2024-04-30	Repair queued
Supporting Statement B- MCHB- PMHCA- New- 04302024.docx	Supporting Statement B	Uploaded 2024-04-30	Repair queued
Supporting Statement A- MCHB- PMHCA- New- 04302024.docx	Supporting Statement A	Uploaded 2024-04-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
267354	Health Professional Impact Survey	Form and Instruction	New	Health Professional Impact Survey
267354	Health Professional Impact Survey	Form and Instruction	New
267352	Family/Caregiver Focus Group Discussion	Form and Instruction	New	Family-Caregiver Focus Group Discussion
267352	Family/Caregiver Focus Group Discussion	Form and Instruction	New
267351	Family/Caregiver Demographic Questionnaire	Form and Instruction	New	Family-Caregiver Demographic Questionanaire
267351	Family/Caregiver Demographic Questionnaire	Form and Instruction	New

ICR Details

OMB Control No: 0906-0097	ICR Reference No: 202404-0906-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Pediatric Mental Health Care Access Program National Impact Study
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: 07/19/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/01/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2027	36 Months From Approved
Responses	42,452	0	0
Time Burden (Hours)	7,228	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The PMHCA Program aims to promote behavioral health integration into pediatric primary care by supporting the development of state, regional, and tribal pediatric mental health care teleconsultation access programs. The PMHCA Program supports pediatric health professionals (HPs) in their delivery of high-quality and timely screening, assessment, treatment, and referrals for children and adolescents with behavioral health conditions through the provision of teleconsultation, care coordination support/navigation (e.g., resource identification and referrals), and training and education. Additionally, the PMHCA Program focuses on achieving health equity related to racial, ethnic, and geographic disparities in access to care, especially in rural and other underserved areas.

---

Authorizing Statute(s): None

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:
	89 FR 8210	02/06/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 31210	04/24/2024
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Family/Caregiver Demographic Questionnaire	3	Family-Caregiver Demographic Questionanaire
Family/Caregiver Focus Group Discussion	2	Family-Caregiver Focus Group Discussion
Health Professional Impact Survey	1	Health Professional Impact Survey

---

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	42,452	0	0	42,452	0	0
Annual Time Burden (Hours)	7,228	0	0	7,228	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 collection.

---

Annual Cost to Federal Government: $792,741

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.     No

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: 05/01/2024

---