View Information Collection Request (ICR) Package
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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:
0930-0402
ICR Reference No:
202412-0930-003
Status:
Active
Previous ICR Reference No:
Agency/Subagency:
HHS/SAMHSA
Agency Tracking No:
Title:
Certified Community Behavioral Health Clinic-Expansion (CCBHC-E)
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 with change
Conclusion Date:
05/22/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/13/2024
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2028
36 Months From Approved
Responses
139,794
0
0
Time Burden (Hours)
25,852
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
SAMHSA is requesting clearance for eleven data collection instruments and forms related to the implementation and impact studies to be conducted as part of the evaluation. The evaluation will provide new information about how grants support adoption of the CCBHC model, how grants influence sustainable expansion of CCBHC capacities beyond the grant period, and how implementation of the model influences client-level outcomes. An evaluation of the IA and PDI grantees specifically provides an opportunity to examine implementation successes and challenges within each area of the certification criteria among a larger and more diverse group of clinics operating in different state and community contexts. By carefully measuring that context and how it changes over time, the evaluation can provide new information about how factors such as alternative sources of funding and state/community support for the model can influence implementation and outcomes. Finally, this evaluation has an opportunity to assess changes in quality of care and longitudinal client-level health, behavioral health, and functional outcomes.
Authorizing Statute(s):
None
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:
89 FR 66427
08/15/2024
30-day Notice:
Federal Register Citation:
Citation Date:
89 FR 10102
12/13/2024
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
5
IC Title
Form No.
Form Name
Client Interview
Client Interview
Client Interview
Consumer/Grantee/Clinic Interviews
Clinic Leadership Interview Protocol, Clinic Staff Interview Protocol, Clinic Partner Organization Interview Protocol, Grantee Interview Guide, Consumer and Family Member Interview Guide
Clinic Leadership Interview Protocol
,
Clinic Staff Interview Protocol
,
Clinic Partner Organization Interview Protocol
,
Grantee Interview Guide
,
Consumer and Family Member Interview Guide
Focus Groups
Parents Caregiver of Youth Focus Group, Youth Client Focus Group, Adult Client Focus Group
Parents Caregiver of Youth Focus Group
,
Youth Client Focus Group
,
Adult Client Focus Group
GPO Interview
GPO Interview Protocol
GPO Interview Protocol
Grantee Survey
Grantee Survey Round 1, Grantee Survey Round 2
Grantee Survey Round 1
,
Grantee Survey Round 2
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
139,794
0
0
139,794
0
0
Annual Time Burden (Hours)
25,852
0
0
25,852
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 Information Collection Request so there is not a change in burden.
Annual Cost to Federal Government:
$1,838,131
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]?
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?
No
Agency Contact:
Alicia Broadus 240 276-0166 alicia.broadus@samhsa.hhs.gov
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:
12/13/2024
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