Immediate Disaster Case Management Intake Assessment

Forms and Documents

Document Name	Status
Supporting Statements with OMB Instructions ECMRS_final 5.25.20.docx Supporting Statement A	2020-05-27

IC Document Collections

IC ID	Document Title	Status
231878	Immediate Disaster Case Management Intake Assessment Other-Multiple Forms	Modified

ICR Details

OMB Control No: 0970-0461	ICR Reference No: 202005-0970-010
Status: Active	Previous ICR Reference No: 201901-0970-009
Agency/Subagency: HHS/ACF	Agency Tracking No: OHSEPR
Title: Immediate Disaster Case Management Intake Assessment
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: 07/14/2020
	Date Received in OIRA: 05/27/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2023	36 Months From Approved	07/31/2020
Responses	11,163	0	630,000
Time Burden (Hours)	11,163	0	630,000
Cost Burden (Dollars)	0	0	0

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Abstract: The primary purpose of the information collection pertains to the implementation of the ACF Office of Human Services Emergency Preparedness and Response's (OHSEPR's) delivery of case management services to individuals and households impacted by a disaster. OHSEPR’s disaster case managers collect information during intake assessments that is utilized to identify a disaster survivor’s unmet needs and connect them with resources. OHSEPR also utilizes this information to target resources and improve its disaster human services operations. The information collection will be used to support ACF/OHSEPR’s goal to quickly identify critical gaps, resources, needs, and services to support State, local and non-profit capacity for disaster case management and to augment and build human service capacity where none exists. All information gathered will be used to (1) provide case management services to survivors and (2) inform the delivery of disaster case management services and programmatic strategies and improvements. The information is collected through an electronic system used by case managers who receive specific training, including use of personal identifying information. The system greatly reduces respondent burden through built-in algorithms that streamlines response options and patterns.

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Authorizing Statute(s): US Code: 42 USC 426 Name of Law: as amended, Robert T. Stafford Disaster Relief and Emergency Assistance Act
  

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:
	85 FR 16947	03/25/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 31782	05/27/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Immediate Disaster Case Management Intake Assessment

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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	11,163	630,000	0	0	-618,837	0
Annual Time Burden (Hours)	11,163	630,000	0	0	-618,837	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: The estimated number of respondents has been updated based on the previous three years of experience. The result is a reduced number of estimated respondents, and therefore overall burden has decreased. There is one modification to the proposed use of resulting aggregate data, to include a use of the data to develop a Quality Assurance/Performance Improvement process.

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Annual Cost to Federal Government: $981,227

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.     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

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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: 05/27/2020

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