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: 0990-0275	ICR Reference No: 202208-0990-003
Status: Active	Previous ICR Reference No: 202007-0990-003
Agency/Subagency: HHS/HHSDM	Agency Tracking No: 19226
Title: Implementation of an Internet & Paper-Based Uniform Data Set for OMH-funded Activities
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/13/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/19/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2026	36 Months From Approved	03/31/2023
Responses	400	0	520
Time Burden (Hours)	300	0	390
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	400	520	-120
Annual Time Burden (Hours)	300	390	-90
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The requested overall burden has been lowered as the estimated number of respondents was reduced from 130 to 100 in this request due to a program change. The program change is related to the change in number of organizations funded by OMH through the research and demonstration program that are asked to use this data collection form.

Annual Cost to Federal Government: $32,768

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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]? Yes

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

Agency Contact: Jasmine Lusane 301 284-2285 jasmine.lusane@hhs.gov