National Evaluation of the Comprehensive Mental Health Services for Children and Their Families Program: Phase VI

Forms and Documents

Document Name	Status
Form Instruments The Nat'l Eval. of theComprehensive Community MH Services for Children - Providers/Administrators Form and Instruction	New
Form Instruments The Nat'l Eval. of theComprehensive Community MH Services for Children - Youth Form and Instruction	New
Form Instruments The Nat'l Eval. of theComprehensive Community MH Services for Children - Caregivers Form and Instruction	New
4B1 EDIF.doc Supplementary Document	2009-11-25
4B2 CIUF.doc Supplementary Document	2009-11-25
4K2 Services and Costs Data Dictionary.doc Supplementary Document	2009-11-25
4C15 RCMAS-2.pdf Supplementary Document	2009-11-25
Phase_VI_Final Supporting Statement 8-6-09 Final.doc Supporting Statement B	2009-08-06
6-2-09 Attachments.zip Supplementary Document	2009-08-06
6-2-09 Attachments.zip Supplementary Document	2009-08-06
6-2-09 Attachments.zip Supplementary Document	2009-08-06
Phase_VI_Final Supporting Statement 11-13-09 Final.doc Supporting Statement A	2009-11-25

IC Document Collections

IC ID	Document Title	Status
190422	The Nat'l Eval. of theComprehensive Community MH Services for Children - Providers/Administrators Form and Instruction	New
190421	The Nat'l Eval. of theComprehensive Community MH Services for Children - Youth Form and Instruction	New
190420	The Nat'l Eval. of theComprehensive Community MH Services for Children - Caregivers Form and Instruction	New

ICR Details

OMB Control No: 0930-0307	ICR Reference No: 200908-0930-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: National Evaluation of the Comprehensive Mental Health Services for Children and Their Families Program: Phase VI
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/08/2009
	Date Received in OIRA: 08/25/2009
Terms of Clearance: Approved consistent with revised documents uploaded on 11/25/2009.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2012	36 Months From Approved
Responses	271,439	0	0
Time Burden (Hours)	28,156	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Community Mental Health Servies Program for Children with Serious Emotional Distrubances supports a broad array of community-based and family-centered services delivered through the system of care model. Most data collection instruments and procedures are built upon those used in the evaluation of Phase VI grantees.

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Authorizing Statute(s): US Code: 5 USC 520 Name of Law: CMHS
  

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:
	74 FR 11593	03/18/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 40200	08/11/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
The Nat'l Eval. of theComprehensive Community MH Services for Children - Caregivers	Instruments	Instruments
The Nat'l Eval. of theComprehensive Community MH Services for Children - Youth	Instruments	Instruments
The Nat'l Eval. of theComprehensive Community MH Services for Children - Providers/Administrators	Instruments	Instruments

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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	271,439	0	0	271,439	0	0
Annual Time Burden (Hours)	28,156	0	0	28,156	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: This is a new data collection.

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Annual Cost to Federal Government: $6,226,387

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

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: 08/25/2009

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