Mental Health Assessment Form, Public Health Investigation Form: Active TB, and Public Health Investigation Form: Non-TB Illness

The Mental Health Assessment Form was approved by OMB on September 16, 2023, as part of the Mental Health Asessment Form, Public Health Investigation Form: Active TB, and Public Health Investigation Form: Non-TB Illness Form information collection. The purpose of the Mental Health Assessment is to collect standardized health information on unaccompanied children during evaluations with mental health providers. The following two Administration for Children and Families (ACF) Office of Refugee Resettlement (ORR) information collections capture health data on children in ORR care: • Medical Assessment Form and Dental Assessment Form • Mental Health Assessment Form and Public Health Investigation Form: Active TB, and Public Health Investigation Form: Non-TB Illness. ORR has recently identified a specific need to share data collected on ORR’s health assessment forms that falls outside of the stated limitations with the Department of Homeland Security (DHS). The need to communicate with DHS occurs when a newly referred child arrives at an ORR facility ill or requires emergent/urgent healthcare services shortly after placement and ORR was not notified in advance. For DHS to investigate the event, ORR must share confidential and sensitive health information including the child’s alien number, name, signs/symptoms, diagnoses, and date of diagnosis. The goal of this data sharing effort is to identify areas of potential improvement in delivery of healthcare services and continuity of care for children transferred from DHS to HHS custody. ACF has implemented changes to update gender collected data to denote sex as a biological variable in current approved information collection requests to comply with recent presidential directives.

The latest form for Mental Health Assessment Form, Public Health Investigation Form: Active TB, and Public Health Investigation Form: Non-TB Illness expires 2026-09-30 and is listed under ICR 202502-0970-014.

View the official OMB control history on Reginfo.gov.

Mental Health Assessment Form - Reporting Time

Federal Enterprise Architecture: Community and Social Services - Social Services

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