Site Visits With Grantees Integrated HIV Primary Care, Sustance Abuse, and Behavioral Health Services

ICR 201212-0930-002

OMB: 0930-0336

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Form and Instruction
New
Supporting Statement B
2013-06-05
Supplementary Document
2012-12-19
Supplementary Document
2012-12-19
Supporting Statement A
2013-06-05
IC Document Collections
ICR Details
0930-0336 201212-0930-002
Historical Active
HHS/SAMHSA
Site Visits With Grantees Integrated HIV Primary Care, Sustance Abuse, and Behavioral Health Services
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 06/20/2013
Retrieve Notice of Action (NOA) 12/20/2012
Within 6 weeks of approval, SAMHSA has agreed to provide OMB with a document specifying the differences and overlaps between this information collection and CDC's information collections concerning HIV.
  Inventory as of this Action Requested Previously Approved
06/30/2016 36 Months From Approved
110 0 0
156 0 0
0 0 0

The goals of the MAI-TCE project are to facilitate the development and expansion of culturally competent and effective integrated behavioral health and primary care, which include HIV services and medical treatment within 11 of the 12 Metropolitan Statistical Areas (MSAs) and Metropolitan Divisions (MDs) most heavily impacted by HIV/AIDS. The program also supports the integration of behavioral health services (i.e., prevention, treatment, and substance abuse) into the CDC's Enhanced Comprehensive HIV Prevention Plans (ECHPP). Interviews conducted with MAI-TCE grantees during site visits are an integral part of efforts to evaluate: (1) the effectiveness of program implementation across the grantee sites; (2) grantee efforts to integrate behavioral health, substance abuse and HIV care; (3) the variety of program models in use across the grantee sites; and, (4) grantee efforts to engage and successfully reach their target populations.

None
None

Not associated with rulemaking

  77 FR 59626 09/28/2012
77 FR 75181 12/19/2012
No

2
IC Title Form No. Form Name
Interview Guide Site Visits Year One Site Visit Interview Guide Site Visits Year One Site Visit Interview Guide
Assessment Form Site Visits Year One Site Visit Form Site Visits Year One Site Visit Form

  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 110 0 0 110 0 0
Annual Time Burden (Hours) 156 0 0 156 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new data collection.

$58,670
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Summer King 2402761243

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/20/2012


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