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Federal forms, ICRs, and supporting documents

OMB control number

Pediatric Mental Health Care Access Program National Impact Study

OMB 0906-0097 · HHS/HRSA.

OMB 0906-0097

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.

The latest form for Pediatric Mental Health Care Access Program National Impact Study expires 2027-07-31 and is listed under ICR 202508-0906-004.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 1 Health Professional Impact SurveyForm and Instruction
Form 1 Health Professional Impact SurveyForm and Instruction
Form 2 Family-Caregiver Focus Group DiscussionForm and Instruction
Form 2 Family/Caregiver Focus Group DiscussionForm and Instruction
Form 3_Revised Family Caregiver Demographic Questionaire Update 02.25.2025)Form and Instruction
Form 3_Revised Family/Caregiver Demographic QuestionnaireForm and Instruction
0906-0097_MCHB_OMB NonSubstantive Change Request_02252025.docxJustification for No Material/Nonsubstantive Change
0906-0097_MCHB_OMB NonSubstantive Change Request_02252025.docx Justification for No Material/Nonsubstantive Change
Attachment B7 - Family-Caregiver Pilot Feedback_Final.docxSupplementary Document
Attachment B7 - Family-Caregiver Pilot Feedback_Final.docx Supplementary Document
Attachment B6 - HP Impact Survey Pilot Feedback_Final.docxSupplementary Document
Attachment B6 - HP Impact Survey Pilot Feedback_Final.docx Supplementary Document
Attachment A12 - IRB Decision Letter.pdfSupplementary Document
Attachment A12 - IRB Decision Letter.pdf Supplementary Document
Attachment A11 - PMHCA FGD Flyer_Final.pdfSupplementary Document
Attachment A11 - PMHCA FGD Flyer_Final.pdf Supplementary Document
Attachment A10 - PMHCA FGD Overview Guide_Final.docxSupplementary Document
Attachment A10 - PMHCA FGD Overview Guide_Final.docx Supplementary Document
Attachment A9 - PMHCA FGD Recruitment Procedures_Final.docxSupplementary Document
Attachment A9 - PMHCA FGD Recruitment Procedures_Final.docx Supplementary Document
Attachment A8 - PMHCA FGD Recruiter Email From JBS_Final.docxSupplementary Document
Attachment A8 - PMHCA FGD Recruiter Email From JBS_Final.docx Supplementary Document
Attachment A7 - PMHCA HP Survey Reminder Email From Program_Final.docxSupplementary Document
Attachment A7 - PMHCA HP Survey Reminder Email From Program_Final.docx Supplementary Document
Attachment A6 - PMHCA HP Survey Participation Email From Program_Final.docxSupplementary Document
Attachment A6 - PMHCA HP Survey Participation Email From Program_Final.docx Supplementary Document
Attachment A5 - PMHCA HP Survey Reminder Email From JBS_Final.docxSupplementary Document
Attachment A5 - PMHCA HP Survey Reminder Email From JBS_Final.docx Supplementary Document
Attachment A4 - PMHCA HP Survey Participation Email From JBS_Final.docxSupplementary Document
Attachment A4 - PMHCA HP Survey Participation Email From JBS_Final.docx Supplementary Document
Attachment A1 - Legislation_Final.docxSupplementary Document
Attachment A1 - Legislation_Final.docx Supplementary Document
Attachment A2 - 60-day FRN Publication_Final.pdfSupplementary Document
Attachment A2 - 60-day FRN Publication_Final.pdf Supplementary Document
Supporting Statement B- MCHB- PMHCA- New- 04302024.docxSupporting Statement B
Supporting Statement B- MCHB- PMHCA- New- 04302024.docxSupporting Statement B
Supporting Statement A- MCHB- PMHCA- New - OIRA- JBS- Clean 07182024.docxSupporting Statement A
Supporting Statement A- MCHB- PMHCA- New - OIRA- JBS- Clean 07182024.docxSupporting Statement A
Health Professional Impact Survey Form and Instruction
Health Professional Impact Survey Form and Instruction
Family/Caregiver Focus Group Discussion Form and Instruction
Family/Caregiver Focus Group Discussion Form and Instruction
Family/Caregiver Demographic Questionnaire Form and Instruction
Family/Caregiver Demographic Questionnaire Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202502-0906-001 No material or nonsubstantive change to a currently approved collection 2025-03-28
202404-0906-009 New collection (Request for a new OMB Control Number) 2024-05-01 Approved with change

OMB Details

Family/Caregiver Demographic Questionnaire

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
FormNameElectronic accessType
Form 3_RevisedFamily Caregiver Demographic Questionaire Update 02.25.2025)Fillable FileableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.