Mental Health Client/Consumer Outcome Measures and Infrastructure, Prevention and Promotion Indicators

Forms and Documents

Document Name	Status
Form Client Level Measu CMHS NOMS Data Collection Tool Form and Instruction	Modified
Form IPP Indicators Infrastructure, Prevention, and Promotion Indicators Form and Instruction	Modified
202404 C_CMHS IPP Results Form.docx Supplementary Document	2025-09-23
0930-0285 No Material or Nonsubstantive Change-CMHS GPRA Tool.docx Justification for No Material/Nonsubstantive Change	2025-09-23
202404 Supporting Statement A (SSA)_0930-0285.docx Supporting Statement A	2024-10-01

IC Document Collections

IC ID	Document Title	Status
46632	CMHS NOMS Data Collection Tool Form and Instruction	Modified
192393	Infrastructure, Prevention, and Promotion Indicators Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0285	ICR Reference No: 202509-0930-011
Status: Received in OIRA	Previous ICR Reference No: 202410-0930-001
Agency/Subagency: HHS/SAMHSA	Agency Tracking No: 18877
Title: Mental Health Client/Consumer Outcome Measures and Infrastructure, Prevention and Promotion Indicators
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/30/2025

	Requested	Previously Approved
Expiration Date	11/30/2027	11/30/2027
Responses	456,088	456,088
Time Burden (Hours)	139,178	139,178
Cost Burden (Dollars)	0	0

---

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. SAMHSA is in the process of establishing a new data collection tool for client services which will be used by discretionary grants from both CMHS and the Center for Substance Abuse Treatment (CSAT). While working towards this new combined data collection, SAMHSA is requesting to extend the time period for data collection using the currently approved tools without change to the tools.

---

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

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 58390	07/18/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 77878	09/24/2024
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
CMHS NOMS Data Collection Tool	Client Level Measures	Client Level Measures
Infrastructure, Prevention, and Promotion Indicators	IPP Indicators	IPP Indicators

---

ICR Summary of Burden

	Total Request	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	456,088	456,088	0	0	0	0
Annual Time Burden (Hours)	139,178	139,178	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: $2,332,000

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

---

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: 09/30/2025

---