Immediate Disaster Case Management Intake Assessment

Forms and Documents

Document Name	Status
Form 1 IDCM Intake Assessment Form and Instruction	Modified
OMB Supporting Statement_OHSEPR_ECMRS_0970-0461.doc Supporting Statement A	2017-09-18
Emer. Req. memo to OIRA 6-5-15.pdf Supplementary Document	2015-06-23

IC Document Collections

IC ID	Document Title	Status
216998	IDCM Intake Assessment Form and Instruction	Modified

ICR Details

OMB Control No: 0970-0461	ICR Reference No: 201709-0970-005
Status: Historical Active	Previous ICR Reference No: 201509-0970-003
Agency/Subagency: HHS/ACF	Agency Tracking No: OHSEPR
Title: Immediate Disaster Case Management Intake Assessment
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 09/22/2017
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/19/2017
	Date Received in OIRA: 09/19/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	6 Months From Approved	11/30/2018
Responses	3,500	0	3,500
Time Burden (Hours)	2,333	0	2,333
Cost Burden (Dollars)	0	0	0

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Abstract: The Office of Human Services Emergency Preparedness and Response (OHSEPR), within the Administration for Children and Families (ACF) seeks to improve the collection and storage of client data and optimize transfer of case files to State, Tribal, or Territorial partners upon Immediate Disaster Case Management (IDCM) program closure. The information collection will serve to optimize services delivered to individuals and households impacted by a disaster. In addition, it will better support State/Tribal/Territorial and Federal planning for disaster survivors' human service needs.

Emergency Justfication: DATE: September 12, 2017 TO: Mr. Josh Brammer, Policy Analyst Office of Management and Budget (OMB) Office of Information and Regulatory Affairs (OIRA) THROUGH: Robert Sargis, Reports Clearance Officer Office of Planning, Research and Evaluation, (OPRE) Administration for Children and Families (ACF) FROM: Roberto Garza, LCDR, U.S Public Health Service, and Acting Director Office of Human Services Emergency Preparedness Response (OHSEPR) Administration for Children and Families (ACF) SUBJECT: Request for the Office of Management and Budget (OMB) to Authorize Emergency Processing for the Submissions of Collections of Information. REQUEST: This is a “revision to OMB Control Number 0970-0461” and we need approval by 9/22. BACKGROUND: Due to the unforeseen climatic events of Hurricane Harvey and Hurricane Irma, the OHSEPR cannot reasonably comply with the normal clearance procedures and is requesting authorization to use the emergency processing procedures under Section 1320.13. The recent climatic events of Hurricane Harvey and Hurricane Irma have created catastrophic disasters in Texas, Louisiana, Puerto Rico, U.S. Virgin Islands, and Florida. President Trump has declared these climatic events as major disaster declarations. FEMA is providing assistances to these states and territories under declaration numbers DR-4332 & DR-4337. There are looming public health issues related to flooding, and especially among at risk populations. Risks include contracting water‐borne and vector‐borne diseases, substance abuse, and mental health concerns, including PTSD, depression, anxiety, and homelessness. Therefore, it is essential for the mission of ACF to activate the Immediate Disaster Case Management (IDCM) Electronic Case Management Record System (ECMRS). The ECMRS will be used to collect and manage information from the disaster affected clients. This information includes demographics, disaster caused unmet needs, and referrals provided. The information collected is critical to develop a recovery plan for each survivor. DATED: September 12, 2017 ________________________ Roberto Garza, LCDR U.S. PHS Acting Director, OHSEPR DATED: September 12, 2017 ________________________ Lisa Swanson ECMRS System Owner (SO) IDCM Program Coordinator, OHSEPR

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Authorizing Statute(s): US Code: 42 USC 5189d Name of Law: 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

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
IDCM Intake Assessment	1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1	Client Intake Demographic Information ,   Clothing Assessment ,   Family Financial Evaluation ,   Food Assessment ,   Furniture and Appliances Assessment ,   Health Insurance and Access to Health Care ,   Housing Assessment ,   Lanaguage Assessment ,   Legal Referral Services ,   Post-Disaster Financial Assessment ,   Pre-Disaster Financial Assessment ,   Senior Services Assessment ,   Transportation Assessment ,   Access to Behavioral Health Assessment ,   Child and Youth Services Assissement

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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	3,500	3,500	0	0	0	0
Annual Time Burden (Hours)	2,333	2,333	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:

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Annual Cost to Federal Government: $183,500

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? 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: 09/19/2017

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