Office of Human Services Emergency Preparedness and Response
Disaster Human Services Case Management Intake Assessment, Resource Referral, and Case Management Plan
OMB Information Collection Request
0970 – 0619
Supporting Statement Part A - Justification
Type of Request: Extension with No Changes
January 2024
Submitted By:
Office of Human Services Emergency Preparedness and Response
Administration for Children and Families
U.S. Department of Health and Human Services
Summary
The Administration for Children and Families (ACF) is requesting an extension with no changes to this information collection, which was originally approved in October 2023 through an emergency review, as authorized under 44 U.S.C. 3507 (subsection j). The forms under this request enable ACF’s Office of Human Services Emergency Preparedness and Response to provide case management support during disasters.
Circumstances Making the Collection of Information Necessary
The Disaster Human Services Case Management (DHSCM) program is authorized through appropriations language under the Children and Families Services account. It is operated by the Administration for Children and Families' (ACF) Office of Human Services Emergency Preparedness and Response (OHSEPR). OHSEPR is the lead in the Department for Health and Human Services (HHS) for human service preparation for, response to, and recovery from, natural disasters. The materials included in this request are necessary for OHSEPR to provide responsive disaster human services case management operations to support families that are currently displaced.
OHSEPR’s previous OMB-approved collection for disaster case management operations was limited to FEMA’s Immediate Disaster Case Management program and the collection expired July 31, 2023. To ensure OHSEPR and ACF could provide disaster human services case management services to disaster survivors during wildfires in Hawai’i in the summer of 2023 that displaced thousands of residents, OHSEPR requested emergency approval for these materials. OHSEPR needs to continue to use these forms to provide adequate and responsive support during disasters. As such, we are requesting an extension to continue to use these materials. No changes are proposed.
Purpose and Use of the Information Collection
OHSEPR will use this information collection to conduct intake assessments of disaster survivors to identify their unmet needs and provide case management services to connect these survivors to human services programs and other referrals that can support their needs. Specifically, OHSEPR’s DHSCM Intake Assessment, Resource Referral, and Case Management Plan collection is part of a system of tools that OHSEPR utilizes in the field to support disaster survivors during DHSCM response missions. The collection includes questions that a DHSCM case manager would use during an intake assessment to identify a disaster survivor’s unmet needs, including behavioral health, housing, child care, elder care, nutrition assistance, transportation, and previous enrollment in human services programs. OHSEPR’s DHSCM case managers will then work with the survivor to develop a case management plan based on the survivor’s responses. The case management plan would include resource referrals for each of the self-reported, unmet needs identified during the intake assessment.
The purpose and use of each information collection follows.
Disaster Human Services Case Management Intake Assessment: This form is used by Case Managers when they meet with disaster survivors during intake to identify unmet, disaster-caused needs.
Case Management Plan: The case management plan serves as a roadmap for disaster survivors to use to address their needs.
Resource Referral Form: Case managers use this form to provide survivors with referrals to service providers.
Case Record Notes: Case managers document their interactions with a survivor on this form.
Survivor Satisfaction Survey: The survey will help evaluate and improve service delivery.
Use of Improved Information Technology and Burden Reduction
This collection will primarily be completed using the OHSEPR’s Electronic Case Management Records System, which is a FISMA and FedRAMPed cloud-based system hosted in an Amazon Web Service environment. The collection may be completed manually during response operations in jurisdictions with limited internet connectivity.
Efforts to Identify Duplication and Use of Similar Information
Duplication of efforts will be addressed through the collection’s questions that determine if a disaster survivor is receiving benefits from another human services program or another federal disaster assistance program for their identified needs. Case managers will coordinate with other agencies, as applicable.
Impact on Small Businesses or Other Small Entities
Not applicable.
Consequences of Collecting the Information Less Frequently
If information was not collected or collected less frequently, disaster survivors will experience disruptions in services as they transition from federally-administered disaster case management operations to state-administered disaster case management operations.
Special Circumstances Relating to the Guidelines of 5 CFR 1320.5
There are no special circumstances for this information collection.
Comments in Response to the Federal Register Notice and Efforts to Consult Outside the Agency
In accordance with the Paperwork Reduction Act of 1995 (Pub. L. 104-13) and Office of Management and Budget (OMB) regulations at 5 CFR Part 1320 (60 FR 44978, August 29, 1995), ACF published a notice in the Federal Register announcing the agency’s intention to request an expedited OMB review of this information collection activity (88 FR 69191). This notice, published on October 4, 2023, alerted the public of a request for emergency approval for six months of data collection and provided a sixty-day comment period related to the full request that will be submitted to continue data collection beyond six months. No comments were received during the 60-day comment period. This full request for an extension is accompanied by a second solicitation for comments published in the Federal Register.
Explanation of Any Payment or Gift to Respondents
No payments or gifts will be provided to respondents.
Assurance of Confidentiality Provided to Respondents
The collection’s Privacy Statement advises respondents that they are authorizing ACF to share their information with ACF’s service providers who can support their self-reported needs. The use and protection of these records are discussed in OHSEPR’s System of Records Notice, for OHESPR Repatriation and Disaster Human Services Case Management Records, 09-80-0389. Respondent information will be kept private and only shared with service providers, as appropriate and needed.
Justification for Sensitive Questions
Intimate partner violence, human trafficking, and child and elder neglect and abuse often increase in communities impacted by a disaster. This collection includes sensitive questions to enable case managers to take actions to prevent and mitigate these risks.
Estimates of Annualized Burden Hours and Costs
OHSEPR’s case managers help disaster survivors complete the collection. The number of disasters that would warrant data collection is estimated at three per year. Due to the unpredictable nature of disasters, the number of respondents is estimated at approximately 9,000. For example, there were 2,200 intake assessments completed in 2011 following Hurricane Irene and Tropical Storm Lee. There were 4,100 intake assessments completed following Super Storm Sandy in 2012. Participation in information collection is voluntary and based on acceptance of case management services. The cost to survivors is calculated based on the estimated time to complete the intake assessment multiplied by the federal minimum wage of $7.25. The average hourly rate for case managers is $35.00. To account for fringe benefits and overhead, the hourly rate ($35.00) is multiplied by two, which is $70.00.
Information Collection Title |
Annual Number of Respondents |
Total Number of Responses Per Respondent |
Average Burden Hours Per Response |
Annual Burden Hours |
Average Hourly Wage |
Total Annual Cost |
Disaster Human Services Case Management Intake Assessment – Survivor |
9,000 |
1 |
1.5 |
13,500 |
$7.25 |
$97,875 |
Case Management Plan – Case Manager |
180 |
50 |
1 |
9,000 |
$70.00 |
$630,000 |
Resource Referral Form – Case Manager |
180 |
50 |
1 |
9,000 |
$70.00 |
$630,000 |
Case Record Notes – Case Manager |
180 |
50 |
1 |
9,000 |
$70.00 |
$630,000 |
Survivor Satisfaction Survey – Survivor |
9,000 |
1 |
.25 |
2,250 |
$7.25 |
$16,312 |
Totals: |
42,750 |
|
$2,004,187 |
|||
Estimates of Other Total Annual Cost Burden to Respondents and Record Keepers
There are no additional costs to respondents.
Annualized Cost to the Federal Government
Case managers are under contract to the federal government. Based on the average hourly wage and including benefits and overhead, the annualized cost to the federal government is $1,890,000.
Explanation for Program Changes or Adjustments
This request is for an extension with no changes.
Plans for Tabulation and Publication and Project Time Schedule
The results of the information collection will not be published.
Reason(s) Display of OMB Expiration Date is Inappropriate
There are no reasons not to display the expiration date.
Exceptions to Certification for Paperwork Reduction Act Submissions
No exceptions are necessary for this information collection.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Mason, Byron (ACF) |
| File Modified | 0000-00-00 |
| File Created | 2025-02-16 |