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:
0906-0105
ICR Reference No:
202505-0906-005
Status:
Active
Previous ICR Reference No:
202410-0906-001
Agency/Subagency:
HHS/HRSA
Agency Tracking No:
Title:
Evaluation of the Maternal and Child Health Bureau Pediatric Mental Health Care Access and Screening and Treatment for Maternal Mental Health and Substance Use Disorders Programs Project
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
06/16/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/02/2025
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2027
12/31/2027
12/31/2027
Responses
29,880
0
29,880
Time Burden (Hours)
10,026
0
10,026
Cost Burden (Dollars)
0
0
0
Abstract:
This information collection will be used to evaluate the Pediatric Mental Health Care Access (PMHCA) Program and the Screening and Treatment for Maternal Mental Health and Substance Use Disorders (MMHSUD) Program. The evaluation will be used to study the efforts of PMHCA and MMHSUD programs to achieve key outcomes (e.g., increase in access to behavioral health services; HPs trained; identification of community-based resources, including counselors or family service providers) and to measure whether and to what extent awardee programs are associated with changes in these outcomes. The evaluation will examine changes over time within and/or across PMHCA and MMHSUD programs, regarding PMHCA- and MMHSUD-enrolled/participating HPs’ and practices’ (1) capacity to address patients’ behavioral health and access to behavioral health care, through screening, assessment, treatment, and referral for behavioral health conditions, and (2) use of program services (i.e., consultation, care coordination, training).
Authorizing Statute(s):
PL:
Pub.L. 114 - 255 10002
Name of Law: 21st Century Cures Act
PL:
Pub.L. 117 - 2 2712
Name of Law: American Rescue Plan Act
PL:
Pub.L. 117 - 159 11005
Name of Law: Bipartisan Safer Communities Act
US Code:
42 USC 247b-13a
Name of Law: Public Health Service Act
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 46143
05/28/2024
30-day Notice:
Federal Register Citation:
Citation Date:
89 FR 81920
10/09/2024
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
8
IC Title
Form No.
Form Name
Behavioral Health Consultation Provider Semi-Structured Interview (SSI)
1A, 1I, 1A, 1I
Attachment 1I - Behavioral Health Consultation Provider SSI PMHCA
,
Attachment 1A - Behavioral Health Consultation Provider SSI MMHSUD
,
1A_MCHB_0906-0105_MMHSUD BH Consultation Provider SSI_Redline
,
1I_MCHB_0906-0105_PMHCA BH Consultation Provider SSI_Redline
Care Coordinator Semi-Structured Interview (SSI)
1B, 1J, 1J, 1B
Attachment 1J - Care Coordinator SSI PMHCA
,
Attachment 1B - Care Coordinator SSI MMHSUD
,
1B_MCHB_0906-0105_MMHSUD Care Coordinator SSI_Redline
,
1J_MCHB_0906-0105_PMHCA Care Coordinator SSI_Redline
Champion Semi-Structured Interview
1C, 1K, 1K, 1C
Attachment 1K - Champion SSI PMHCA
,
Attachment 1C - Champion SSI MMHSUD
,
1C_MCHB_0906-0105_MMHSUD Champion SSI_Redline
,
1K_MCHB_0906-0105_PMHCA Champion SSI_Redline.docx
Community-based and Other Resources Semi-Structured Interview (SSI)
1D, 1L, 1L, 1D
Attachment 1L - Community-Based and Other Resources SSI PMHCA
,
Attachment 1D - Community-Based and Other Resources SSI MMHSUD
,
1D_MCHB_0906-0105_MMHSUD Community Resources SSI_Redline
,
1L_MCHB_0906-0105_PMHCA Community Resources SSI_Redline
Health Professional Survey
1E, 1M, 1M, 1E
Attachment 1M - Health Professional Survey PMHCA
,
Attachment 1E - Health Professional Survey MMHSUD
,
1E_MCHB_0906-0105_MMHSUD Health Professional Survey_Redline
,
1M_MCHB_0906-0105_MCHB_PMHCA Health Professional Survey_Redline
Practice-Level Survey
1F, 1N, 1N, 1F
Attachment 1N - Practice Level Survey PMHCA
,
Attachment 1F - Practice Level Survey MMHSUD
,
1F_MCHB_0906-0105_MMHSUD Practice Level Survey_Redline
,
1N_MCHB_0906-0105_MCHB_PMHCA Practice Level Survey_Redline
Program Implementation Semi-Structured Interview (SSI)
1G, 1O, 1O, 1G
Attachment 1O - Program Implementation SSI PMHCA
,
Attachment 1G - Program Implementation SSI MMHSUD
,
1G_MCHB_0906-0105_MMHSUD Program Implementation SSI_Redline
,
1O_MCHB_0906-0105_MCHB_PMHCA Program Implementation SSI_Redline
Program Implementation Survey
1H, 1P, 1P, 1H
Attachment 1P - Program Implementation Survey PMHCA
,
Attachment 1H - Program Implementation Survey MMHSUD
,
1H_MCHB_0906-0105_MMHSUD Program Implementation Survey_Redline
,
1P_MCHB_0906-0105_PMHCA Program Implementation Survey_Redline
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
29,880
29,880
0
0
0
0
Annual Time Burden (Hours)
10,026
10,026
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
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:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$804,666
Does this IC contain surveys, censuses, or employ statistical methods?
No
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.
Yes
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:
Laura Cooper 301 443-2126 lcooper@hrsa.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:
06/02/2025
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