40200 Federal Register / Vol. 74, No. 153 / Tuesday, August 11, 2009 / Notices 

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—NEW 

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 and 

performance. Data will be collected on 

26 service systems, and approximately 

5,541 children and families. 

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 sixmonth intervals. The length of time that 

individual families will participate in 

the study ranges from 12 to 24 months 

depending upon when they enter the 

evaluation. 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, with a sustainability 

survey conducted in years 3 and 5. 

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. We will 

also conduct a comprehensive 

evaluation of the CMHI’s data driven 

technical assistance; this component of 

the evaluation will employ a mixedmethods approach, combining 

qualitative and quantitative data to 

provide a comprehensive assessment of 

the continuous quality improvement 

(CQI) process in funded system of care 

communities. Specifically, data will be 

gathered through three complementary 

activities: A baseline survey of key 

constituents in all funded communities; 

a subsequent monitoring survey 

administered every two years to the 

same constituents; and biennial case 

studies of four selected communities. 

In addition, the evaluation will 

include three special studies: (1) The 

sector specific assessment and quasiexperimental 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; (2) The Alumni 

Network Study will examine the 

effectiveness of the system of care 

Alumni Network web site by evaluating 

end-user satisfaction and usability of the 

web site and will also assess the 

collaboration between communities via 

a Web-based Networking and 

Collaboration Survey that will measure 

the nature and extent of the interaction 

between communities; (3) The Study of 

State Strategies for Sustainability will 

examine the state’s role in sustaining 

communities after federal funding 

ceases and describe effective strategies 

for sustaining funded systems of care. A 

short version of the sustainability 

survey developed for this evaluation 

will be used to gather this information. 

Internet-based technology such as 

Web-based surveys and data entry and 

management tools will be used in this 

evaluation. The measures of the national 

evaluation address 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. 

PHASE VI ESTIMATE OF RESPONDENT BURDEN

[Note: Total burden is annualized over a 5-year period] 

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 Guide A. Core 

Agency Representative.

Key site informants ............ 1 828 3 1.00 2,484 497 

Interview Guide B. Project 

Director.

Interview Guide C. Family 

Representative/Representative of Family/Advocacy Organizations.

Interview Guide D. Program 

Evaluator.

Interview Guide E. Intake 

Worker.

Interview Guide F. Care Coordinator.


sroberts on DSKD5P82C1PROD with NOTICES
Federal Register / Vol. 74, No. 153 / Tuesday, August 11, 2009 / Notices 40201 

PHASE VI ESTIMATE OF RESPONDENT BURDEN—Continued 

[Note: Total burden is annualized over a 5-year period] 

Instrument Respondent Number of 

respondents 

Total average 

number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

5-Year average annual 

burden hours 

Interview Guide G. Direct 

Service Delivery Staff.

Interview Guide H. Care 

Review Participant.

Interview Guide I. Caregiver 

of Child or Youth Served 

by the Program.

Interview Guide L. Direct 

Service Staff from Other 

Public Child-Serving 

Agencies.

Interview Guide M. Care 

Record/Chart Review.

Interview Guide N. Other 

Staff.

Interview Guide O. Debriefing Document.

Interview Guide P. Youth 

Respondent.

Interview Guide Q. Youth 

Coordinator.

Interview Guide R. Cultural 

and Linguistic Competence Coordinator.

Interview Guide S. Social 

Marketing Communications Manager.

Child and Family Outcome Study 

Caregiver Information Questionnaire, Revised: Caregiver—Intake (CIQ–RC–I).Caregiver ............................ 2 7,550 1 0.37 2,768 554 

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 ............................ 7,550 3 4 0.28 8,557 1,711 

Caregiver Information Questionnaire, Revised: Staff 

as Caregiver—Follow-Up 

(CIQ–RS–F).

Staff as Caregiver.

Caregiver Strain Questionnaire (CGSQ).Caregiver ............................ 7,550 5 0.17 6,304 1,261 

Child Behavior Checklist 

11⁄2–5 (CBCL 11⁄2–5).

Caregiver ............................ 7,550 5 0.33 12,571 2,514 

Child Behavior Checklist 6– 

18 (CBCL 6–18).

Education Questionnaire, 

Revision 2 (EQ–R2).

Caregiver ............................ 7,550 5 0.33 12,571 2,514 

Living Situations Questionnaire (LSQ).Caregiver ............................ 7,550 5 0.08 3,133 627 

Behavioral and Emotional 

Rating Scale—Second 

Edition, Parent Rating 

Scale (BERS–2C).

Caregiver ............................ 4 6,675 5 0.17 5,574 1,115 

Columbia Impairment Scale 

(CIS).

Caregiver ............................ 5 7,282 5 0.08 3,022 604 

Parenting Stress Index 

(PSI).

Caregiver ............................ 6 2,862 5 0.08 1,193 239 

Devereux Early Childhood 

Assessment for Infants 

(DECA 1–18M).

Caregiver ............................ 7 2,176 5 0.08 907 181 


sroberts on DSKD5P82C1PROD with NOTICES
40202 Federal Register / Vol. 74, No. 153 / Tuesday, August 11, 2009 / Notices 

PHASE VI ESTIMATE OF RESPONDENT BURDEN—Continued 

[Note: Total burden is annualized over a 5-year period] 

Instrument Respondent Number of 

respondents 

Total average 

number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

5-Year average annual 

burden hours 

Devereux Early Childhood 

Assessment for Toddlers 

(DECA 18–36M).

Devereux Early Childhood 

Assessment (DECA 2– 

5Y).

Preschool Behavioral and 

Emotional Rating 

(PreBERS).

Caregiver ............................ 2,176 5 0.10 1,088 218 

Delinquency Survey, Revised (DS–R).Youth .................................. 8 4,896 5 0.13 3,264 653 

Behavioral and Emotional 

Rating Scale—Second 

Edition, Youth Rating 

Scale (BERS–2Y).

Youth .................................. 4,896 5 0.17 4,088 818 

Gain Quick—R: Substance 

Problem Scale (GAIN).

Youth .................................. 4,896 5 0.08 2,032 406 

Substance Use Survey, Revised (SUS–R).Youth .................................. 4,896 5 0.10 2,448 490 

Revised Children’s Manifest 

Anxiety Scales (RCMAS).

Youth .................................. 4,896 5 0.05 1,224 245 

Reynolds Adolescent Depression Scale—Second 

Edition (RADS–2).

Youth .................................. 4,896 5 0.05 1,224 245 

Youth Information Questionnaire, Revised—Intake 

(YIQ–R–I).

Youth .................................. 4,896 1 0.25 1,224 245 

Youth Information Questionnaire, Revised—FollowUp (YIQ–R–F).Youth .................................. 4,896 4 0.25 4,896 979 

Service Experience Study 

Multi-Sector Service Contacts, Revised: Caregiver—Intake (MSSC– 

RC–I).

Caregiver ............................ 7,550 1 0.25 1,888 378 

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 ............................ 7,550 4 0.25 7,550 1,510 

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 ............................ 7,550 9 4 0.13 4,027 805 

Youth Services Survey for 

Families (YSS–F).

Caregiver ............................ 7,550 4 0.12 3,533 707 

Youth Services Survey 

(YSS).

Youth .................................. 4,896 4 0.08 1,625 325 

Comparison and Sector Study: Juvenile Justice 

Court Representative Questionnaire (CRQ).Court representatives ......... 10 212 5 0.50 530 106 

Electronic Data Transfer of 

Juvenile Justice Records.

Key site personnel ............. 212 5 0.03 35 7 

Comparison and Sector Study: Education 

Teacher Questionnaire (TQ) Teacher .............................. 212 5 0.50 530 106 


sroberts on DSKD5P82C1PROD with NOTICES
Federal Register / Vol. 74, No. 153 / Tuesday, August 11, 2009 / Notices 40203 

PHASE VI ESTIMATE OF RESPONDENT BURDEN—Continued 

[Note: Total burden is annualized over a 5-year period] 

Instrument Respondent Number of 

respondents 

Total average 

number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

5-Year average annual 

burden hours 

School Administrator Questionnaire (SAQ).School administrators ......... 212 5 0.50 530 106 

Electronic Data Transfer of 

Education Records.

Key site personnel ............. 212 5 0.03 35 7 

Comparison and Sector Study: Child Welfare 

Child Welfare Sector Study 

Questionnaire—Intake 

(CWSQ–I).

Care coordinators ............... 212 1 0.50 106 21 

Child Welfare Sector Study 

Questionnaire—Follow-Up 

(CWSQ–F).

Care coordinators ............... 212 4 0.50 424 85 

Electronic Data Transfer of 

Child Welfare Records.

Key site personnel ............. 212 5 0.03 35 7 

Sustainability Study 

Sustainability Survey: Brief 

Form.

Project Director .................. 79 2 0.17 26 5 

Sustainability Survey ........... Providers11 ......................... 156 2 0.75 234 47 

Caregiver 11 ........................ 52 2 0.75 78 16 

CQI Initiative Evaluation 

CQI Baseline Survey, WebBased.Key site personnel ............. 288 1 0.50 144 29 

CQI Monitoring Survey, 

Web-Based.

Key site personnel ............. 288 2 0.50 288 58 

CQI Local Focus Group 

Guide.

Key site personnel ............. 30 2 1.00 60 12 

CQI National Focus Group 

Guide.

National TA providers ......... 20 2 1.00 40 8 

Alumni Networking Study 

Networking and Collaboration Survey.Key site personnel ............. 302 2 0.50 302 60 

Alumni Network Web Site 

Satisfaction Survey.

Key site personnel, National TA providers, 

Branch staff.

512 2 0.25 256 51 

Services and Costs Study 

Flex Funds Data Dictionary/ 

Tool.

Local programming staff 

compiling/entering administrative data on children/ 

youth.

12 1,808 13 3 0.03 179 36 

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.

7,550 14 100 0.05 37,750 7,550 

Summary of Annualized Burden Estimates for 5 Years 

Number of distinct 

respondents 

Average 

annual number 

of responses 

per 

respondent 

Total annual 

number of 

responses 

Average 5- 

year burden 

per response 

(hours) 

Total annual 

burden 

(hours) 15

Caregivers ........................... 550 ..................................... 0.9 78,572 2.2 14,953 

Youth ................................... 4,896 .................................. 0.9 38,189 1.0 4,405 

Providers/Administrators ..... 828 ..................................... 11.4 154,678 1.0 8,798 


sroberts on DSKD5P82C1PROD with NOTICES
40204 Federal Register / Vol. 74, No. 153 / Tuesday, August 11, 2009 / Notices 

PHASE VI ESTIMATE OF RESPONDENT BURDEN—Continued 

[Note: Total burden is annualized over a 5-year period] 

Instrument Respondent Number of 

respondents 

Total average 

number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

5-Year average annual 

burden hours 

Total Summary ............ 13,274 ................................ ........................ 271,439 ........................ 28,156 

1An average of 23 stakeholders in up to 26 grant communities will complete the System of Care Assessment interview. These stakeholders 

will include site administrative staff, providers, agency representatives, family representatives, and youth. 2 Number of respondents across 26 grantees (5223), in addition to 318 children/families from the comparison sample. Average based on a 5 

percent attrition rate at each data collection point. 3 Number of responses per respondent is five over the course of the study (once every 6 months for 24 months, with one baseline/intake response, and 4 follow-up responses). 4Approximate number of caregivers with children over age 5, based on Phase IV data submitted as of 12/08. Also includes 318 children/families from the comparison sample. 5Approximate number of caregivers with children 3 and older, based on Phase IV data submitted as of 12/08. Also includes 318 children/families from the comparison sample. 6Approximate number of caregivers with either: (1) Children served at the roughly 7 early childhood-focused communities, for whom the instrument is required; or (2) children aged 0 to 12 at other communities, where the instrument is optional (we estimate that 1⁄3 of caregivers will be 

administered the instrument when it is optional). Estimates are based on Phase IV data submitted as of 12/08. 7Approximate number of caregivers with either: (1) Children served at the roughly 7 early childhood-focused communities, for whom the instrument is required; or (2) children aged 0 to 5 at other communities, where the instrument is optional (we estimate that 1⁄3 of caregivers will be administered the instrument when it is optional). Estimates are based on Phase IV data submitted as of 12/08. 8Based on Phase IV finding that approximately 63 percent of the children in the evaluation were 11 years old or older. Also includes 318 children/families from the comparison sample. 9With the exception of the MSSC–R, respondents only complete Service Experience Study measures at follow-up points. See Footnote #3 for 

the explanation about the average number of responses per respondent. 10Approximate number of children/families in each sector, for the Sector and Comparison Study. This includes cases within the communities, 

as well as within the comparison sample. 11For each community, 1 respondent will be a caregiver and 3 respondents will be administrators/providers. 12Assumes that each community will use flexible funds expenditures on average for approximately one quarter of the children/youth enrolled. 13Assumes that three expenditures, on average, will be spent on each child/youth receiving flexible fund benefits. 14Assumes that each child/youth in system of care communities and in the comparison sample will have 100 service episodes, on average. 15Total Annual Burden (hours) is the product of Number of Distinct Respondents × Average Annual Number of Responses per Respondent × 

Average 5-Year Burden per Response (hours). 

Written comments and 

recommendations concerning the 

proposed information collection should 

be sent by September 10, 2009 to: 

SAMHSA Desk Officer, Human 

Resources and Housing Branch, Office 

of Management and Budget, New 

Executive Office Building, Room 10235, 

Washington, DC 20503; due to potential 

delays in OMB’s receipt and processing 

of mail sent through the U.S. Postal 

Service, respondents are encouraged to 

submit comments by fax to: 202–395– 

5806. 

Dated: August 5, 2009. 

Elaine Parry, 

Director, Office of Program Services. 

[FR Doc. E9–19228 Filed 8–10–09; 8:45 am] 

BILLING CODE 4162–20–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Submission for OMB Review; 

Comment Request 

Title: ACF Uniform Project 

Description. 

OMB No.: 0970–0139. 

Description: The Administration for 

Children and Families (ACF) has more 

than 50 discretionary grant programs. 

The proposed information collection 

form would be a uniform discretionary 

application form eligible for use by 

grant applicants to submit project 

information in response to ACF program 

announcements. ACF would use this 

information, along with other OMBapproved information collections, to 

evaluate and rank applicants and 

protect the integrity of the grantee 

selection process. All ACF discretionary 

grant programs would be eligible but not 

required to use this application form. 

The application consists of general 

information and instructions; the 

Standard Form 424 series that requests 

basic information, budget information 

and assurances; the Project Description 

requesting the applicant to describe how 

these objectives will be achieved; along 

with assurances and certifications. 

Guidance for the content of information 

requested in the Project Description is 

found in OMB Circular A–102 and 45 

CFR Part 74. 

Respondents: Applicants for ACF 

Discretionary Grant Programs. 

ANNUAL BURDEN ESTIMATES

Instrument Number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden hours 

per response 

Total 

burden hours 

UPD ............................................................................................................... 6,752 1 40 270,080 

Estimated Total Annual Burden 

Hours: 270,080 

Additional Information: Copies of the 

proposed collection may be obtained by 

writing to the Administration for 

Children and Families, Office of 

Administration, Office of Information 

Services, 370 L’Enfant Promenade, SW., 

Washington, DC 20447, Attn: ACF 

Reports Clearance Officer. All requests 

should be identified by the title of the 


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