# Agency Information Collection Activities: Submission for OMB Review; Comment Request > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/fr%3A2012-14200 ## Record - **Collection:** Federal Register - **Document type:** Notice - **Published:** June 12, 2012 - **Citation:** 77 FR 34961 ## Text DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Agency Information Collection Activities: Submission for OMB Review; Comment Request Periodically, the Substance Abuse and Mental Health Services Administration (SAMHSA) will publish a summary of information collection requests under OMB review, in compliance with the Paperwork Reduction Act (44 U.S.C. Chapter 35). To request a copy of these documents, call the SAMHSA Reports Clearance Officer on (240) 276-1243. Project: National Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program: Phase VI (OMB No. 0930-0307)—REVISION The Substance Abuse and Mental Health Services Administration (SAMHSA), Center of Mental Health Services is responsible for the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program (Children's Mental Health Initiative—CMHI) that will collect data on child mental health outcomes, family life, and service system development. Data will be collected on 47 service systems, and approximately 6,561 children and families. Principal changes from the previous Phase VI OMB approval include: • Addition of nine (9) communities awarded cooperative agreements in FY2010 for data collection. • Replacement of intake and follow-up questionnaires for the Child Welfare Sector and Comparison Study with an administrative record review form to lessen burden. • Addition of a brief 8-item Education Sector Caregiver Questionnaire to the Education Sector and Comparison Study to capture family involvement in the development and use of Individualized Education Plans (IEPs). • Removal of data collection activities for the Alumni Networking Study, the CQI Initiative Evaluation, and the Sustainability Study. Data collection for this evaluation will be conducted over a five-year period. Child and family outcomes of interest will be collected at intake and during subsequent follow-up sessions at six-month intervals. The length of time that individual families will participate in the study is up to 24 months. The outcome measures include the following: Child symptomatology and functioning, family functioning, satisfaction, and caregiver strain. The core of service system data will be collected every 18-24 months throughout the 5-year evaluation period. Service utilization and cost data will be tracked and submitted to the national evaluation every six months using two tools: The Flex Fund Tool and the Services and Costs Data Tool to estimate average cost of treatment per child, distribution of costs, and allocation of costs across service categories. Service delivery and system variables of interest include the following: Maturity of system of care development in funded system of care communities, adherence to the system of care program model, and client service experience. In addition, the evaluation will include one special study: The Sector and Comparison Study will examine in more detail the outcomes and service experience of children from multiple child-serving sectors and, through child-level matching, compare these outcomes with those not receiving system of care services. Internet-based technology such as data entry and management tools will be used in this evaluation. The measures of the national evaluation address annual Congressional reporting requirements of the program's authorizing legislation, and the national outcome measures for mental health programs as currently established by SAMHSA. The average annual respondent burden is estimated below. The estimate reflects the average number of respondents in each respondent category, the average number of responses per respondent per year, the average length of time it will take to complete each response, and the total average annual burden for each category of respondent, and for all categories of respondents combined. Instrument Respondent Number of respondents Total average number of responses per respondent Hours per response Total burden hours 5-Year average annual burden hours System of Care Assessment Interview Guides A-S Key site informants 1081 3 1.00 3,243 649 Child and Family Outcome Study Caregiver Information Questionnaire, Revised: Caregiver—Intake (CIQ-RC-I) Caregiver 6,561 1 0.37 2,406 481 Caregiver Information Questionnaire, Revised: Staff as Caregiver—Intake (CIQ-RS-I) Staff as Caregiver Caregiver Information Questionnaire, Revised: Caregiver—Follow-Up (CIQ-RC-F) Caregiver 6,561 4 0.28 7,436 1,487 Caregiver Information Questionnaire, Revised: Staff as Caregiver—Follow-Up (CIQ-RS-F) Staff as Caregiver Caregiver Strain Questionnaire (CGSQ) Caregiver 6,561 5 0.17 5,478 1,096 Child Behavior Checklist 1 1/2 -5 (CBCL 1 1/2 -5) Caregiver 6,561 5 0.33 10,924 2,185 Child Behavior Checklist 6-18 (CBCL 6-18) Education Questionnaire, Revision 2 (EQ-R2) Caregiver 6,561 5 0.33 10,924 2,185 Living Situations Questionnaire (LSQ) Caregiver 6,561 5 0.08 2,723 545 Behavioral and Emotional Rating Scale—Second Edition, Parent Rating Scale (BERS-2C) Caregiver 5,389 5 0.17 4,500 900 Columbia Impairment Scale (CIS) Caregiver 6,281 5 0.08 2,607 521 Parenting Stress Index (PSI) Caregiver 2,151 5 0.08 896 179 Devereux Early Childhood Assessment for Infants (DECA 1-18M) Caregiver 1,576 5 0.08 657 131 Devereux Early Childhood Assessment for Toddlers (DECA 18-36M) Devereux Early Childhood Assessment (DECA 2-5Y) Preschool Behavioral and Emotional Rating (PreBERS) Caregiver 1,576 5 0.10 788 158 Delinquency Survey, Revised (DS-R) Youth 3,986 5 0.13 2,657 531 Behavioral and Emotional Rating Scale—Second Edition, Youth Rating Scale (BERS-2Y) Youth 3,986 5 0.17 3,328 666 Gain Quick-R: Substance Problem Scale (GAIN) Youth 3,986 5 0.08 1,654 331 Substance Use Survey, Revised (SUS-R) Youth 3,986 5 0.10 1,993 399 Revised Children's Manifest Anxiety Scale, Second Edition (RCMAS-2) Youth 3,986 5 0.07 1,329 266 Reynolds Adolescent Depression Scale, Second Edition (RADS-2) Youth 3,986 5 0.05 997 199 Youth Information Questionnaire, Revised—Intake (YIQ-R-I) Youth 3,986 1 0.25 997 199 Youth Information Questionnaire, Revised—Follow-Up (YIQ-R-F) Youth 3,986 4 0.25 3,986 797 Service Experience Study Multi-Sector Service Contacts, Revised: Caregiver—Intake (MSSC-RC-I) Caregiver 6,561 1 0.25 1,640 328 Multi-Sector Service Contacts, Revised: Staff as Caregiver—Intake (MSSC-RS-I) Staff as Caregiver Multi-Sector Service Contacts, Revised: Caregiver—Follow-Up (MSSC-RC-F) Caregiver 6,561 4 0.25 6,561 1,312 Multi-Sector Service Contacts, Revised: Staff as Caregiver—Follow-Up (MSSC-RS-F) Staff as Caregiver Cultural Competence and Service Provision Questionnaire, Revised (CCSP-R) Caregiver 6,561 4 0.13 3,499 700 Youth Services Survey for Families (YSS-F) Caregiver 6,561 4 0.12 3,071 614 Youth Services Survey (YSS) Youth 3,986 4 0.08 1,323 265 Comparison and Sector Study: Juvenile Justice Court Representative Questionnaire (CRQ) Court representatives 202 5 0.50 505 101 Electronic Data Transfer of Juvenile Justice Records Key site personnel 202 5 0.03 34 7 Comparison and Sector Study: Education Teacher Questionnaire (TQ) Teacher 202 5 0.50 505 101 School Administrator Questionnaire (SAQ) School administrators 202 5 0.50 505 101 Electronic Data Transfer of Education Records Key site personnel 202 5 0.03 34 7 Education Sector Caregiver Questionnaire (ESCQ) Caregiver 202 5 0.08 81 16 Comparison and Sector Study: Child Welfare Electronic Data Transfer of Child Welfare Records Key site personnel 202 5 0.03 34 7 Services and Costs Study Flex Funds Data Dictionary/Tool Local programming staff compiling/entering administrative data on children/youth 1,565 3 0.03 155 31 Services and Costs Data Dictionary/Data Entry Application Local evaluator, staff at partner agencies, and programming staff compiling/entering service and cost records on children/youth 6,561 100 0.05 32,805 6,561 Respondent Number of respondents Number of responses/ respondent Average burden/ response Total average annual burden Caregiver 6,561 0.9 2.2 12,838 Youth 3,986 0.9 1.1 3,653 Provider/Administrator 1,081 12.9 0.5 7,564 Total 11,628 24,055 Written comments and recommendations concerning the proposed information collection should be sent by July 12, 2012 to the SAMHSA Desk Officer at the Office of Information and Regulatory Affairs, Office of Management and Budget (OMB). To ensure timely receipt of comments, and to avoid potential delays in OMB's receipt and processing of mail sent through the U.S. Postal Service, commenters are encouraged to submit their comments to OMB via email to: OIRA_Submission@omb.eop.gov. Although commenters are encouraged to send their comments via email, commenters may also fax their comments to: 202-395-7285. Commenters may also mail them to: Office of Management and Budget, Office of Information and Regulatory Affairs, New Executive Office Building, Room 10102, Washington, DC 20503. Summer King, Statistician. [FR Doc. 2012-14200 Filed 6-11-12; 8:45 am] BILLING CODE 4162-20-P --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/fr%3A2012-14200. Public record. Not legal advice.