Mental Health Client/Participant Outcome Measures

Forms and Documents

Document Name	Status
Form Section H Client-Level Form and Instruction	Modified
Form IPP Infrastructure, Development, Prevention MH Abstraction Form and Instruction	Modified
Final Supporting Statement B 9.19.18.docx Supporting Statement B	2018-09-25
Final 0285 CMHS SSA 2 25 19.docx Supporting Statement A	2019-02-26

IC Document Collections

IC ID	Document Title	Status
46632	Client-Level Form and Instruction	Modified
192393	Infrastructure, Development, Prevention MH Abstraction Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0285	ICR Reference No: 201802-0930-002
Status: Active	Previous ICR Reference No: 201612-0930-003
Agency/Subagency: HHS/SAMHSA	Agency Tracking No: 18877
Title: Mental Health Client/Participant Outcome Measures
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/27/2019
	Date Received in OIRA: 09/27/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2022	36 Months From Approved	01/31/2020
Responses	194,564	0	148,882
Time Burden (Hours)	104,168	0	78,096
Cost Burden (Dollars)	0	0	0

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Abstract: SAMHSA and its Centers will use the data collected for annual reporting required by GPRMA, to describe and understand changes in outcomes from baseline to follow-up to discharge. SAMHSA’s report for each fiscal year will include actual results of performance monitoring for the three preceding fiscal years. Information collected through this request will allow SAMHSA to report on the results of these performance outcomes as well as be consistent with SAMHSA-specific performance domains, and to assess the accountability and performance of its discretionary grant programs. The additional information collected through this request will allow SAMHSA to improve its ability to assess the impact of its programs on key outcomes of interest and to gather vital diagnostic information about clients served by CMHS discretionary grant programs.

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Authorizing Statute(s): US Code: 5 USC 1105 Name of Law: GPRA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 19792	05/04/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 48643	09/25/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Client-Level	Section H, Adult Tool, Child Tool	Section H ,   Child Tool ,   Adult Tool
Infrastructure, Development, Prevention MH Abstraction	IPP	IPP

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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	194,564	148,882	0	45,682	0	0
Annual Time Burden (Hours)	104,168	78,096	0	26,072	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: Currently, there are 78,096 total burden hours in the OMB-approved inventory and SAMHSA is now requesting 104,168 burden hours. The program change is an increase of 26,072 burden hours is due to the addition of the 13 questions on the Adult Measure and seven (7) questions on the Child/Caregiver Measure, the increased number of overall grant programs, the increased frequency of physical health data collection, and the number of respondents receiving mental health treatment services. The estimated time to complete the revised tools has been increased from 35 minutes to 40 minutes, and the estimated time to complete the Section H physical health indicators has been increased from 5 minutes to 15 minutes.

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Annual Cost to Federal Government: $2,332,000

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? Uncollected

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Common Form ICR:  No

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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: 09/27/2018

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