Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access and Screening and Treatment for Maternal Mental Health and Substance Use Disorders Programs Project

Forms and Documents

Document Name	Status
Form B4 Program Implementation Semi-Structured Interview (SSI) Form and Instruction	New
Form B6 Community-based and Other Resources Semi-Structured Interview (SSI) Form and Instruction	New
Form B7 Champion Semi-Structured Interview Form and Instruction	New
Form B5 Care Coordinator Semi-Structured Interview (SSI) Form and Instruction	New
Form B8 Behavioral Health Consultation Provider Semi-Structured Interview (SSI) Form and Instruction	New
Form B3 Program Implementation Survey Form and Instruction	New
Form B2 Practice-Level Survey Form and Instruction	New
Form B1 Health Professional Survey Form and Instruction	New
Attachment B17 - Pilot Testing Feedback.docx Supplementary Document	2024-10-09
AG19-001 Expedited Review Approval Letter 7-23-2024.docx Supplementary Document	2024-10-09
Attachment A45 - Program Implementation Survey Reminder Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A44 - Program Implementation Survey Participation Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A43 - Program Implementation Survey Email Notification - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A42 - Program Implementation SSI Reminder Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A41 - Program Implementation SSI Participation Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A40 - Program Implementation SSI Notification Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A39 - Practice Survey Reminder Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A38 - Practice Survey Reminder Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A37 - Practice Survey Participation Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A36 - Practice Survey Participation Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A35 - Practice Survey Notification Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A34 - Practice-Level Survey Notification Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A33 - Health Professional Survey Reminder Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A32 - Health Professional Survey Reminder Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A31 - Health Professional Survey Participation Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A30 - Health Professional Survey Participation Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A29 - Health Professional Survey Notification Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A28 - Health Professional Survey Notification Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A27 - Community Resources SSI Reminder Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A26 - Community Resources SSI Reminder Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A25 - Community Resources SSI Participation - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A24 - Community Resources SSI Participation - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A23 - Community Resources SSI Email Notification - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A22 - Community Resources SSI Email Notification - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A21 - Champion SSI Reminder Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A20 - Champion SSI Reminder Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A19 - Champion SSI Participation Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A18 - Champion SSI Participation Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A17 - Champion SSI Email Notification - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A16 - Champion SSI Email Notification - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A15 - Care Coordinator SSI Reminder Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A14 - Care Coordinator SSI Reminder Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A13 - Care Coordinator SSI Participation Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A12 - Care Coordinator SSI Participation Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A11 - Care Coordinator SSI Notification Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A10 - Care Coordinator SSI Notification Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A9 - Behavioral Health Consultation Provider SSI Reminder Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A8 - Behavioral Health Consultation Provider SSI Reminder Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A7 - Behavioral Health Consultation Provider SSI Participation Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A6 - Behavioral Health Consultation Provider SSI Participation Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A5 - Behavioral Health Consultation Provider SSI Notification Email - Awardee_Final.docx Supplementary Document	2024-10-09
Attachment A4 - Behavioral Health Consultation Provider SSI Notification Email - JBS_Final.docx Supplementary Document	2024-10-09
Attachment A2_60 Day FRN - PMHCA and MMHSUDS.pdf Supplementary Document	2024-10-09
Attachment A3 - 60-day FRN Comments and Responses 7-31-24.docx Supplementary Document	2024-10-09
Attachment A1 - Legislation_Final OMB.docx Supplementary Document	2024-10-09
Supporting Statement B_09092024.docx Supporting Statement B	2024-10-09
Supporting Statement A_09162024.docx Supporting Statement A	2024-10-09

IC Document Collections

IC ID	Document Title	Status
271506	Program Implementation Semi-Structured Interview (SSI) Form and Instruction	New
271505	Community-based and Other Resources Semi-Structured Interview (SSI) Form and Instruction	New
271504	Champion Semi-Structured Interview Form and Instruction	New
271503	Care Coordinator Semi-Structured Interview (SSI) Form and Instruction	New
271502	Behavioral Health Consultation Provider Semi-Structured Interview (SSI) Form and Instruction	New
271501	Program Implementation Survey Form and Instruction	New
271500	Practice-Level Survey Form and Instruction	New
271499	Health Professional Survey Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202410-0906-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access and Screening and Treatment for Maternal Mental Health and Substance Use Disorders Programs Project
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/10/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	29,880	0
Time Burden (Hours)	10,026	0
Cost Burden (Dollars)	0	0

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Abstract: This information collection will be used to evaluate the Pediatric Mental Health Care Access (PMHCA) Program and the Screening and Treatment for Maternal Mental Health and Substance Use Disorders (MMHSUD) Program. The evaluation will be used to study the efforts of PMHCA and MMHSUD programs to achieve key outcomes (e.g., increase in access to behavioral health services; HPs trained; identification of community-based resources, including counselors or family service providers) and to measure whether and to what extent awardee programs are associated with changes in these outcomes. The evaluation will examine changes over time within and/or across PMHCA and MMHSUD programs, regarding PMHCA- and MMHSUD-enrolled/participating HPs’ and practices’ (1) capacity to address patients’ behavioral health and access to behavioral health care, through screening, assessment, treatment, and referral for behavioral health conditions, and (2) use of program services (i.e., consultation, care coordination, training).

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Authorizing Statute(s): PL: Pub.L. 114 - 255 10002 Name of Law: 21st Century Cures Act
   PL: Pub.L. 117 - 2 2712 Name of Law: American Rescue Plan Act
   PL: Pub.L. 117 - 159 11005 Name of Law: Bipartisan Safer Communities Act
   US Code: 42 USC 247b-13a Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 46143	05/28/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 81920	10/09/2024
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 8

IC Title	Form No.	Form Name
Behavioral Health Consultation Provider Semi-Structured Interview (SSI)	B16, B8	Attachment B8 - Behavioral Health Consultation Provider SSI PMHCA ,   Attachment B16 - Behavioral Health Consultation Provider SSI MMHSUD
Care Coordinator Semi-Structured Interview (SSI)	B5, B13	Attachment B5 - Care Coordinator SSI PMHCA ,   Attachment B13 - Care Coordinator SSI MMHSUD
Champion Semi-Structured Interview	B7, B15	Attachment B7 - Champion SSI PMHCA ,   Attachment B15 - Champion SSI MMHSUD
Community-based and Other Resources Semi-Structured Interview (SSI)	B6, B14	Attachment B6 - Community-Based and Other Resources SSI PMHCA ,   Attachment B14 - Community-Based and Other Resources SSI MMHSUD
Health Professional Survey	B1, B9	Attachment B1 - Health Professional Survey PMHCA ,   Attachment B9 - Health Professional Survey MMHSUD
Practice-Level Survey	B2, B10	Attachment B2 - Practice Level Survey PMHCA ,   Attachment B10 - Practice Level Survey MMHSUD
Program Implementation Semi-Structured Interview (SSI)	B4, B12	Attachment B4 - Program Implementation SSI PMHCA ,   Attachment B12 - Program Implementation SSI MMHSUD
Program Implementation Survey	B3, B11	Attachment B3 - Program Implementation Survey PMHCA ,   Attachment B11 - Program Implementation Survey MMHSUD

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ICR Summary of Burden

	Total Request	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	29,880	0	0	29,880	0	0
Annual Time Burden (Hours)	10,026	0	0	10,026	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

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Annual Cost to Federal Government: $804,666

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

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Common Form ICR:  No

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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: 10/10/2024

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