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Burden
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View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0930-0365
ICR Reference No:
201605-0930-003
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/SAMHSA
Agency Tracking No:
Title:
Primary and Behavioral Health Care Integration Evaluation
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
09/30/2016
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/29/2016
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/2019
36 Months From Approved
Responses
6,973
0
0
Time Burden (Hours)
10,882
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
The purpose of the PBHCI grants is to improve the overall wellness and physical health of people with serious mental illness (SMI), including people with co-occurring substance use disorders, by helping communities coordinate and integrate primary care services into publicly funded, community-based settings providing mental health and behavioral health care. This data will help SAMHSA assess whether integrated primary care services produce improvements in the physical and mental health of the SMI population receiving services from community-based behavioral health agencies.
Authorizing Statute(s):
US Code:
42 USC 290
Name of Law: Data Collection
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
81 FR 12917
03/11/2016
30-day Notice:
Federal Register Citation:
Citation Date:
81 FR 29570
05/12/2016
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
8
IC Title
Form No.
Form Name
Comparison Group Clinic Director Coordination
Extraction of Grantee Registry/EHR Data
Electronic Data Collection Tool
Electronic Data Collection Tool
Focus Groups
Electronic Data Collection Tool
Electronic Data Collection Tool
Grantee - Site Visits
On-site Staff Interview Protocol
On-site Staff Interview Protocol
Grantee Director - Phone
Telephone Interview Protocol
Telephone Interview Protocol
Grantee Director - Web
Director Survey
Director Survey
Grantee Frontline Staff Survey
Staff Survey
Staff Survey
SMI Clients
Client Health Assessment Questionnaire
Client Health Assessment Questionnaire
ICR Summary of Burden
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
6,973
0
0
6,973
0
0
Annual Time Burden (Hours)
10,882
0
0
10,882
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 data collection.
Annual Cost to Federal Government:
$1,352,874
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
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?
Uncollected
Agency Contact:
Summer King 2402761243
Common Form ICR:
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:
(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:
06/29/2016
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