1114 Federal Register / Vol. 86, No. 4 / Thursday, January 7, 2021 / Notices 

Jeffrey M. Zirger, 

Lead, Information Collection Review Office, 

Office of Scientific Integrity, Office of Science, 

Centers for Disease Control and Prevention. 

[FR Doc. 2021–00003 Filed 1–6–21; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Child Care and Development 

Fund (CCDF) ACF–696T Financial 

Report (OMB #0970–0195) 

AGENCY: Office of Child Care, 

Administration for Children and 

Families, HHS. 

ACTION: Request for public comment. 

SUMMARY: The Administration for 

Children and Families (ACF) is 

requesting a 3-year extension of the 

form ACF–696T: Child Care and 

Development Fund Annual Financial 

Report. This form is currently approved 

under the ACF Generic Clearance for 

Financial Reports (OMB #0970–0510; 

expiration May 31, 2021), and ACF is 

proposing to reinstate the previous OMB 

number under which this form had been 

approved. There are no changes 

requested to the form. 

DATES: Comments due within 60 days of 

publication. In compliance with the 

requirements of Section 3506(c)(2)(A) of 

the Paperwork Reduction Act of 1995, 

ACF is soliciting public comment on the 

specific aspects of the information 

collection described above. 

ADDRESSES: Copies of the proposed 

collection of information can be 

obtained and comments may be 

forwarded by emailing infocollection@

acf.hhs.gov. Alternatively, copies can 

also be obtained by writing to the 

Administration for Children and 

Families, Office of Planning, Research, 

and Evaluation (OPRE), 330 C Street 

SW, Washington, DC 20201, Attn: ACF 

Reports Clearance Officer. All requests, 

emailed or written, should be identified 

by the title of the information collection. 

SUPPLEMENTARY INFORMATION: 

Description: The ACF–696T Financial 

Report along with the instruction for 

completion of Form ACF–696T 

Financial Reporting Form for the Child 

Care and Development Fund (CCDF) are 

being submitted for renewal with no 

changes. The form collects CCDF 

financial expenditures data for the 221 

Tribal Lead Agencies that receive CCDF 

funding. This report form is submitted 

annually by the referenced CCDF grant 

recipients. The form collects 

expenditures data for all respondents 

that receive CCDF funding. 

Respondents: The 221 Tribal Lead 

Agencies that receive CCDF funding. 

ANNUAL BURDEN ESTIMATES

Instrument 

Annual 

number of 

respondents 

Annual 

number of 

responses per 

respondent 

Average 

burden hours 

per response 

Annual 

burden hours 

Child Care and Development Fund ACF–696T Financial Report ........... 221 1 5 1,105 

Estimated Total Annual Burden 

Hours: 1,105. 

Comments: The Department 

specifically requests comments on (a) 

whether the proposed collection of 

information is necessary for the proper 

performance of the functions of the 

agency, including whether the 

information shall have practical utility; 

(b) the accuracy of the agency’s estimate 

of the burden of the proposed collection 

of information; (c) the quality, utility, 

and clarity of the information to be 

collected; and (d) ways to minimize the 

burden of the collection of information 

on respondents, including through the 

use of automated collection techniques 

or other forms of information 

technology. Consideration will be given 

to comments and suggestions submitted 

within 60 days of this publication. 

Authority: Section 658G(d), Pub. L. 113– 

186, 128 Stat. 1971. 

Mary B. Jones, 

ACF/OPRE Certifying Officer. 

[FR Doc. 2021–00017 Filed 1–6–21; 8:45 am] 

BILLING CODE 4184–43–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Mental Health Care Services 

for Unaccompanied Alien Children 

(New Collection) 

AGENCY: Office of Refugee Resettlement, 

Administration for Children and 

Families, Department of Health and 

Human Services. 

ACTION: Request for public comment. 

SUMMARY: The Office of Refugee 

Resettlement (ORR), Administration for 

Children and Families (ACF), U.S. 

Department of Health and Human 

Services (HHS), is inviting public 

comments on the proposed collection. 

The request consists of several forms 

that allow the Unaccompanied Alien 

Children (UAC) Program to provide 

mental health care services to UAC. 

DATES: Comments due within 60 days of 

publication. In compliance with the 

requirements of Section 3506(c)(2)(A) of 

the Paperwork Reduction Act of 1995, 

ACF is soliciting public comment on the 

specific aspects of the information 

collection described above. 

ADDRESSES: Copies of the proposed 

collection of information can be 

obtained and comments may be 

forwarded by emailing infocollection@

acf.hhs.gov. Alternatively, copies can 

also be obtained by writing to the 

Administration for Children and 

Families, Office of Planning, Research, 

and Evaluation (OPRE), 330 C Street 

SW, Washington, DC 20201, Attn: ACF 

Reports Clearance Officer. All requests, 

emailed or written, should be identified 

by the title of the information collection. 

SUPPLEMENTARY INFORMATION: 

Description 

1. Initial Mental Health Evaluation 

(Form MH–1): This instrument is used 

by clinicians to document the UAC’s 

mental state upon arrival to the care 

provider facility. It includes an 

assessment of the UAC’s current mental 

state, psychiatric history, and substance 

use history. 

2. Columbia Suicide Severity Rating 

Scale (SSRS) Risk Assessment (Form 

MH–2): This instrument is used by 

clinicians to assess suicide risk for UAC 

who verbalize or demonstrate suicidal 

thoughts or behavior. It is a shorter 

version of the standard Columbia SSRS 

used to triage mental health care for 

UAC, a tool designed to support suicide 


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Federal Register / Vol. 86, No. 4 / Thursday, January 7, 2021 / Notices 1115 

risk assessment through a series of 

simple, plain-language questions that 

anyone can ask. The Columbia SSRS 

includes the most essential, evidencesupported questions required for a 

thorough assessment. Further 

information about the Columbia SSRS 

can be found at https://

cssrs.columbia.edu/the-columbia-scalec-ssrs/about-the-scale/. 

3. Mental Health Group Event (Form 

MH–3): This instrument is used by 

clinicians to document group 

counseling or community meetings held 

at the care provider program. 

4. Clinical Contact Log (Form MH–4): 

This instrument is used by clinicians to 

document the following mental health 

services: Individual counseling, group 

counseling, community meetings, 

family counseling sessions, screenings/ 

evaluations, and collateral contact with 

services providers involved in the 

UAC’s case. Mental Health Group 

Events (Form MH–3) may be linked to 

a Clinical Contact Log entry. 

5. Mental Health Referral (Form MH– 

5): This instrument is used by clinicians 

and/or medical coordinators to refer a 

UAC for community-based mental 

health care services (assessments/ 

evaluations, psychotherapy, medical 

referrals, and treatment), acute and longterm psychiatric hospitalizations, and 

referrals to out-of-network residential 

treatment centers. 

6. Mental Health Service Report 

(Form MH–6): This instrument is used 

by clinicians and/or medical 

coordinators to document the provision 

of community-based mental health care 

services (assessments/evaluations, 

psychotherapy, medical referrals, and 

treatment), acute and long-term 

psychiatric hospitalizations, and 

referrals to out-of-network residential 

treatment centers. In addition, the UAC 

interview portion of the Out-of-Network 

Site Visit Report (Form M–3B), which is 

part of a different information collection 

request, is accessible from within this 

instrument. 

7. Mental Health Task (Form MH–7): 

This instrument is auto-generated to 

create reminders for clinicians and/or 

medical coordinators of tasks that must 

be completed. Clinicians and/or medical 

coordinators may edit the instrument 

after it is generated. 

Respondents: ORR grantee and 

contractor staff, and UAC. 

ANNUAL BURDEN ESTIMATES

Instrument 

Annual total 

number of 

respondents 

Annual total 

number of 

responses per 

respondent 

Average 

burden minutes 

per response 

Annual total 

burden hours 

Initial Mental Health Evaluation (Form MH–1) .............................................. 216 241 60 52,056 

Columbia SSRS Risk Assessment (Form MH–2) ......................................... 216 5 45 810 

Mental Health Group Event (Form MH–3) .................................................... 216 156 10 5,616 

Clinical Contact Log (Form MH–4) ................................................................ 216 11,194 10 402,984 

Mental Health Referral (Form MH–5) ............................................................ 216 24 45 3,888 

Mental Health Service Report (Form MH–6) ................................................. 216 31 45 5,022 

Mental Health Task (Form MH–7) ................................................................. 216 55 5 990 

Estimated Annual Burden Hours Total: .................................................. ........................ ........................ .......................... 471,366 

Comments: The Department 

specifically requests comments on (a) 

whether the proposed collection of 

information is necessary for the proper 

performance of the functions of the 

agency, including whether the 

information shall have practical utility; 

(b) the accuracy of the agency’s estimate 

of the burden of the proposed collection 

of information; (c) the quality, utility, 

and clarity of the information to be 

collected; and (d) ways to minimize the 

burden of the collection of information 

on respondents, including through the 

use of automated collection techniques 

or other forms of information 

technology. Consideration will be given 

to comments and suggestions submitted 

within 60 days of this publication. 

Authority: 6 U.S.C. 279; 8 U.S.C. 1232; 

Flores v. Reno Settlement Agreement, No. 

CV85–4544–RJK (C.D. Cal. 1996). 

Mary B. Jones, 

ACF/OPRE Certifying Officer. 

[FR Doc. 2021–00001 Filed 1–6–21; 8:45 am] 

BILLING CODE 4184–45–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Child Care and Development 

Fund (CCDF) ACF–696 Financial 

Report (OMB #0970–0163) 

AGENCY: Office of Child Care, 

Administration for Children and 

Families, HHS. 

ACTION: Request for public comment. 

SUMMARY: The Administration for 

Children and Families (ACF) is 

requesting a 3-year extension of the 

form ACF–696: Child Care and 

Development Fund (CCDF) Quarterly 

Financial Report. This form is currently 

approved under the ACF Generic 

Clearance for Financial Reports (OMB 

#0970–0510; expiration May 31, 2021), 

and ACF is proposing to reinstate the 

previous OMB number under which this 

form had been approved. There are no 

changes requested to the form. 

DATES: Comments due within 60 days of 

publication. In compliance with the 

requirements of Section 3506(c)(2)(A) of 

the Paperwork Reduction Act of 1995, 

ACF is soliciting public comment on the 

specific aspects of the information 

collection described above. 

ADDRESSES: Copies of the proposed 

collection of information can be 

obtained and comments may be 

forwarded by emailing infocollection@

acf.hhs.gov. Alternatively, copies can 

also be obtained by writing to the 

Administration for Children and 

Families, Office of Planning, Research, 

and Evaluation (OPRE), 330 C Street 

SW, Washington, DC 20201, Attn: ACF 

Reports Clearance Officer. All requests, 

emailed or written, should be identified 

by the title of the information collection. 

SUPPLEMENTARY INFORMATION: 

Description: The ACF–696 Financial 

Report along with the instructions for 

completion of Form ACF–696, Financial 

Reporting Form for CCDF are being 

submitted for renewal with no changes 

under a previous OMB number. The 

form collects CCDF financial 

expenditures data for the 50 States, the 

District of Columbia, and five U.S. 

Territories that receive CCDF funding 

(American Samoa, Commonwealth of 


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