Certified Community Behavioral Health Clinic-Expansion (CCBHC-E)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CCBHC-E EHR Data I CCBHC-E EHR Data Instructions for Grantees	Form and Instruction	New	Available
Copy of Copy of EHR Data Codebook and Template_clean.xlsx	Supplementary Document	Uploaded 2026-07-15	Available
CCBHC-E CSE OMB Package - Supporting Statement A_EHR.docx	Supporting Statement A	Uploaded 2026-07-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
281513	CCBHC-E EHR Data Instructions for Grantees	Form and Instruction	New	CCBHC-E EHR Data Instructions for Grantees

ICR Details

OMB Control No:	ICR Reference No: 202607-0930-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Certified Community Behavioral Health Clinic-Expansion (CCBHC-E)
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: 07/16/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	596	0
Time Burden (Hours)	4,768	0
Cost Burden (Dollars)	0	0

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Abstract: The evaluation presents an opportunity to provide SAMHSA, policymakers, and the wider behavioral health community with new information about how these grants support adoption of the CCBHC model, how they influence sustainable expansion of CCBHC capacities beyond the grant period, and how implementation of the model influences client-level outcomes. An evaluation of the IA and PDI grantees specifically provides an opportunity to examine implementation successes and challenges within each area of the certification criteria among a larger and more diverse group of clinics operating in different state and community contexts. By carefully measuring these contexts and how they change over time, the evaluation can provide new information about how factors such as alternative sources of funding and state/community support for the model influence implementation and outcomes. Finally, this evaluation will assess changes in the quality of care and longitudinal client-level health, behavioral health, and functional outcomes.

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Authorizing Statute(s): None

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:
	91 FR 21299	04/21/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 39629	06/30/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
CCBHC-E EHR Data Instructions for Grantees	CCBHC-E EHR Data Instructions for Grantees	CCBHC-E EHR Data Instructions for Grantees

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ICR Summary of Burden

table that charts list 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	596	0	0	596	0	0
Annual Time Burden (Hours)	4,768	0	0	4,768	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 so there is not an increase in burden.

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Annual Cost to Federal Government: $1,838,131

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.     No

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: 07/16/2026

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