CRS Parent Materials

National Mental Health Study Field Test,
Supporting Statement
Attachment M-2 – CRS Data Collection
Materials (Parent Only)

U.S. Department of Health and
Human Services

Parent CRS Follow-Up
Study Description

As you know, your adolescent was selected to take part in a special telephone follow-up
study for the National Mental Health Study (NMHS). This study is sponsored by the
Substance Abuse and Mental Health Services Administration (SAMHSA) and the National
Institute of Mental Health (NIMH), both part of the U.S. Department of Health and Human
Services (DHHS). This study will ask additional questions about various mental health issues
your adolescent may have experienced.
We would also like you to take part in the follow-up National Mental Health Study Parent
Interview to answer additional questions about your adolescent’s health, development, and
family background. A parent’s perspective is very important in getting an accurate
description of an adolescent’s health and development. Knowledge gained from this study
will improve our understanding of adolescents’ mental health issues in the United States. The
interview will be conducted over the phone and takes on average 30 minutes to complete.
Your participation is voluntary. If you agree to complete the interview, you will receive
$30 today.
If you agree to participate, we will ask for your name and telephone number. This
information will be used only to contact you for the telephone interview. Your name and
telephone number will not be included on the interview forms on which your answers will be
written or on any interview audio files that might be recorded for quality assurance. While
the interview has some personal questions, federal law protects the privacy of your answers
and requires us to keep all of your answers confidential. Any data that you provide will only
be used by authorized personnel for statistical purposes according to the Confidential
Information Protection and Statistical Efficiency Act of 2002.
You may consider some questions to be sensitive, and some questions also may make you
feel certain emotions, such as sadness. Remember that you can refuse to answer any
questions, and you can stop the interview at any time. If you become upset at any time
during the interview and wish to speak to a mental health professional about how you are
feeling, the interviewer can provide you with the toll-free hotline numbers.
If you have questions about the study, call the Project Representative at 1-800-XXX-XXXX. If
you have questions about your rights as a study participant, call RTI’s Office of Research
Protection at 1-866-214-2043 (a toll-free number). You can also visit our project website:
https://www.nmhsweb.org for more information. Thank you for your cooperation and time.
Your confidentiality is protected by the Confidential Information Protection and Statistical
Efficiency Act of 2002 (CIPSEA, PL 107-347). Any project staff or authorized data user who
violates CIPSEA may be subject to a jail term of up to 5 years, a fine of up to $250,000, or
both.

Lisa J. Colpe, Ph.D., MPH
National Study Director, DHHS

Grace Medley
National Field Director, DHHS

NOTICE: Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, Paperwork Reduction Project (XXXX-XXXX);
Room 15E57B; 5600 Fishers Lane, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a currently valid OMB control number. The OMB control number for this project is XXXX-XXXX, expiration date XX/XX/XX.