Evaluation of the Certified Community Behavioral Health Clinic Demonstration in Accordance with the Bipartisan Safer Communities Act

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CCBHC Evaluation- BSCA OMB_SSB_7 10 24.docx	Supporting Statement B	Uploaded 2025-05-15	Available
CCBHC Evaluation- BSCA OMB_SSB_7 10 24.docx	Supporting Statement B	Uploaded 2025-05-15	Repair queued
CCBHC Evaluation- BSCA OMB_SSA_ 11 1 24.docx	Supporting Statement A	Uploaded 2025-05-15	Available
CCBHC Evaluation- BSCA OMB_SSA_ 11 1 24.docx	Supporting Statement A	Uploaded 2025-05-15	Missing upstream
Attachment E. CCBHC Demo Eval Clinic Survey_OMB 3 19 25.docx	Supplementary Document	Uploaded 2025-05-15	Available
Attachment E. CCBHC Demo Eval Clinic Survey_OMB 3 19 25.docx	Supplementary Document	Uploaded 2025-05-15	Repair queued
Attachment C. CCBHC Demo Eval Client Focus Group Protocol_OMB.docx	Supplementary Document	Uploaded 2025-05-15	Available
Attachment C. CCBHC Demo Eval Client Focus Group Protocol_OMB.docx	Supplementary Document	Uploaded 2025-05-15	Repair queued
Attachment B. CCBHC Demo Eval Clinic Interview Protocol_OMB.docx	Supplementary Document	Uploaded 2025-05-15	Available
Attachment B. CCBHC Demo Eval Clinic Interview Protocol_OMB.docx	Supplementary Document	Uploaded 2025-05-15	Repair queued
Attachment A. CCBHC Demo Eval State Official Interview Protocol_OMB.docx	Supplementary Document	Uploaded 2025-05-15	Available
Attachment A. CCBHC Demo Eval State Official Interview Protocol_OMB.docx	Supplementary Document	Uploaded 2025-05-15	Repair queued
30-day FRN Template 11 1 24 CCBHC.docx	Supplementary Document	Uploaded 2025-05-15	Available
30-day FRN Template 11 1 24 CCBHC.docx	Supplementary Document	Uploaded 2025-05-15	Repair queued
Attachment D. CCBHC Demo Eval Client Focus Group Consent Form_OMB.docx	Supplementary Document	Uploaded 2024-10-16	Available
Attachment D. CCBHC Demo Eval Client Focus Group Consent Form_OMB.docx	Supplementary Document	Uploaded 2024-10-16	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
271660	Client Focus Group Protocol	Instruction	Unchanged
271659	State Official Interviews	Instruction	Unchanged
271658	CCBHC Interview Protocol	Instruction	Unchanged
271656	CCBHC - Evaluation Clinic Survey	Other-Survey	Unchanged

ICR Details

OMB Control No: 0990-0493	ICR Reference No: 202505-0990-001
Status: Active	Previous ICR Reference No: 202410-0990-001
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Evaluation of the Certified Community Behavioral Health Clinic Demonstration in Accordance with the Bipartisan Safer Communities Act
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 without change	Conclusion Date: 09/24/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/15/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2028	36 Months From Approved
Responses	334	0	0
Time Burden (Hours)	1,079	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services (HHS) is requesting Office of Management and Budget (OMB) approval for qualitative and survey data collection activities to support the evaluation of the Certified Community Behavioral Health Clinic (CCBHC) demonstration program in accordance with the Bipartisan Safer Communities Act. Quantitative data collection activities with their respective OMB approval numbers are described further in the final paragraph of this section.

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Authorizing Statute(s): PL: Pub.L. 113 - 93 223 Name of Law: Protecting Access to Medicare 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 59121	07/22/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 88296	11/07/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
CCBHC - Evaluation Clinic Survey
CCBHC Interview Protocol
Client Focus Group Protocol
State Official Interviews

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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	334	0	0	334	0	0
Annual Time Burden (Hours)	1,079	0	0	1,079	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 information collection request.

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Annual Cost to Federal Government: $182,473

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: 05/15/2025

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