Information Collection Request

Pediatric Mental Health Care Access Program National Impact Study

ICR 202508-0906-004 · OMB unassigned · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 1 Health Professional Impact Survey (Michigan Grantee Only) Form and Instruction Modified Available
Form 1 Health Professional Impact Survey Form and Instruction Modified Available
Form 2 Family-Caregiver Focus Group Discussion Form and Instruction Unchanged Available
Form 3_Revised Family Caregiver Demographic Questionaire Update 02.25.2025) Form and Instruction Unchanged Available
OMB NonSubstantive Change Request_HPI MI PMHCA 8-22-25.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-08-22 Available
0906-0097_MCHB_OMB NonSubstantive Change Request_02252025.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-03-14 Available
Attachment B7 - Family-Caregiver Pilot Feedback_Final.docx Supplementary Document Uploaded 2024-04-30 Available
Attachment B6 - HP Impact Survey Pilot Feedback_Final.docx Supplementary Document Uploaded 2024-04-30 Available
Attachment A12 - IRB Decision Letter.pdf Supplementary Document Uploaded 2024-04-30 Available
Attachment A11 - PMHCA FGD Flyer_Final.pdf Supplementary Document Uploaded 2024-04-30 Available
Attachment A10 - PMHCA FGD Overview Guide_Final.docx Supplementary Document Uploaded 2024-04-30 Available
Attachment A9 - PMHCA FGD Recruitment Procedures_Final.docx Supplementary Document Uploaded 2024-04-30 Available
Attachment A8 - PMHCA FGD Recruiter Email From JBS_Final.docx Supplementary Document Uploaded 2024-04-30 Available
Attachment A7 - PMHCA HP Survey Reminder Email From Program_Final.docx Supplementary Document Uploaded 2024-04-30 Available
Attachment A6 - PMHCA HP Survey Participation Email From Program_Final.docx Supplementary Document Uploaded 2024-04-30 Available
Attachment A5 - PMHCA HP Survey Reminder Email From JBS_Final.docx Supplementary Document Uploaded 2024-04-30 Available
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 Available
Attachment A2 - 60-day FRN Publication_Final.pdf Supplementary Document Uploaded 2024-04-30 Available
Supporting Statement B- MCHB- PMHCA- New- 04302024.docx Supporting Statement B Uploaded 2024-04-30 Available
Supporting Statement A- MCHB- PMHCA- New - OIRA- JBS- Clean 07182024.docx Supporting Statement A Uploaded 2024-07-18 Available
IC Document Collections
IC IDCollectionTypeStatusForm
267354 Health Professional Impact Survey Form and Instruction ModifiedHealth Professional Impact Survey (Michigan Grantee Only)
267354 Health Professional Impact Survey Form and Instruction ModifiedHealth Professional Impact Survey
267352 Family/Caregiver Focus Group Discussion Form and Instruction UnchangedFamily-Caregiver Focus Group Discussion
267351 Family/Caregiver Demographic Questionnaire Form and Instruction UnchangedFamily Caregiver Demographic Questionaire Update 02.25.2025)
ICR Details
0906-0097 202508-0906-004
Active 202502-0906-001
HHS/HRSA
Pediatric Mental Health Care Access Program National Impact Study
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 09/03/2025
Retrieve Notice of Action (NOA) 08/22/2025
  Inventory as of this Action Requested Previously Approved
07/31/2027 07/31/2027 07/31/2027
42,452 0 42,452
7,228 0 7,228
0 0 0

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.

None
None

Not associated with rulemaking

  89 FR 8210 02/06/2024
89 FR 31210 04/24/2024
Yes

  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 42,452 0 0 0 0
Annual Time Burden (Hours) 7,228 7,228 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$792,741
No
    Yes
    No
No
No
No
No
Laura Cooper 301 443-2126 [email protected]

  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:
 
 
 
 
 
 
 
    (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.
08/22/2025