Mental Health Block Grant Ten Percent Set Aside Evaluation

OMB 0930-0376

The purpose of this 3-year evaluation is to assess the relationship between fidelity of selected coordinated specialty care (CSC) programs supported with Mental Health Block Grant (MHBG) Ten Percent Set Aside funding and participant outcomes. There are approximately 250 sites implementing CSC programs with MHBG ten percent set aside funding. All 250 sites will be asked to report on their implementation through an online survey. Up to 32 CSC sites across the nation will be recruited to participate in a process and outcome evaluation.

The latest form for Mental Health Block Grant Ten Percent Set Aside Evaluation expires 2020-08-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form Possible Admin. Da Possible Admin. Data Elements Form and Instruction
Form Fidelity Interview Fidelity Interview Form and Instruction
Form State MH Authority State MH Authority Interview Form and Instruction
Form CSC Participant In CSC Participant Interview Form and Instruction
Form CSC Staff Intervie CSC Staff Interview Form and Instruction
Form Agency Director/Ad Agency Director/Administrator Interview Form and Instruction
Form Site Survey Site Survey Form and Instruction
OMB_Supporting_Statement_A 6-19-17.docx Supporting Statement A
OMB_Supporting_Statement_B 6-15-17.docx Supporting Statement B
Possible Admin. Data Elements Form and Instruction
Fidelity Interview Form and Instruction
State MH Authority Interview Form and Instruction
CSC Participant Interview Form and Instruction
CSC Staff Interview Form and Instruction
Agency Director/Administrator Interview Form and Instruction
Site Survey Form and Instruction

All Historical Document Collections

201706-0930-001

Approved without change

New collection (Request for a new OMB Control Number)

2017-06-21

OMB Details

Site Survey

Federal Enterprise Architecture: Health - Public Health Monitoring

Form Site Survey

Site Survey

Fillable Fileable

Form and instruction

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