Federal Register / Vol. 75, No. 101 / Wednesday, May 26, 2010 / Notices 29551 

Dated: May 20, 2010. 

Maryam I. Daneshvar, 

Reports Clearance Officer, Centers for Disease 

Control and Prevention. 

[FR Doc. 2010–12665 Filed 5–25–10; 8:45 am] 

BILLING CODE 4163–18–P 

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: FASD Diagnosis and 

Intervention Programs in the Fetal 

Alcohol Spectrum Disorder (FASD) 

Center of Excellence—New 

Since 2001, SAMHSA’s Center for 

Substance Abuse Prevention has been 

operating a Fetal Alcohol Spectrum 

Disorder (FASD) Center of Excellence 

which addresses FASD mainly by 

providing trainings and technical 

assistance and developing and 

supporting systems of care that respond 

to FASD using effective evidence-based 

practices and interventions. 

Currently the integration of evidencebased practices into service delivery 

organizations is being accomplished 

through subcontracts. One such 

intervention which integrates diagnosis 

and intervention strategies into existing 

service delivery organizations is the 

FASD Diagnosis and Intervention 

programs targeting children 0–18 years 

of age. The Diagnosis and Intervention 

programs use the following 11 data 

collection tools. 

DESCRIPTION OF INSTRUMENTS/ACTIVITY FOR THE DIAGNOSIS AND INTERVENTION PROGRAMS

Instrument/Activity Description 

Screening and Diagnosis Tool ..................................................... The purpose of the screening and diagnosis tool is to determine eligibility to 

participate in the SAMHSA FASD Center Diagnosis and Treatment Intervention. The form includes demographic, screening, and diagnostic data. 

Positive Monitor Tracking ............................................................ The Positive Monitor Tracking form is to monitor the outcome of placing a child 

(ages 0–3 years) on a positive monitor. 

Services Child is Receiving at the time of the FASD Diagnosis The Services Child is Receiving at the time of the FASD Diagnosis form is to 

record services the child is receiving at the time of an FASD diagnosis. 

Services Planned and Provided based on Diagnostic Evaluation The Services Planned and Provided based on Diagnostic Evaluation form is to 

record services planned and received based on the diagnostic evaluation. 

Services Delivery Tracking Form ................................................. The Services Delivery Tracking form is for the services provided during every 

visit. 

End of Intervention/Program Improvement Measure—Case 

Manager.

The End of Intervention/Program Improvement Measure—Case Manager form 

is for the case manager to report on the overall improvement in the child as 

a result of receiving services. 

End of Intervention/Program Improvement Measure—Parent/ 

Guardian.

The End of Intervention/Program Improvement Measure—Parent/Guardian 

form is for the parent/guardian to report on the overall improvement in the 

child as a result of receiving services. 

End of Intervention/Program Customer Satisfaction with Service The End of Intervention/Program Customer Satisfaction with Service form is to 

determine customer satisfaction (parents) with the SAMHSA FASD Center 

Diagnosis and Intervention project. 

Outcome Measures (Children 0–7 years) ................................... The Outcome Measures (Children 0–7 years) form is an outcomes measure 

checklist used to record measures every six months from start of service to 

end of service, at end of intervention, at 6 months follow-up, and 12 months 

follow-up. 

Outcome Measures (Children 8–18 years) ................................. The Outcome Measures (Children 8–18 years) form is an outcomes measure 

checklist used to record measures every six months from start of service to 

end of service, at end of intervention, at 6 months follow-up, and 12 months 

follow-up. 

Lost to follow-up ........................................................................... The Lost to follow-up form is used if the child is no longer accessible for follow-up. 

Eight subcontracts were awarded in 

February 2008 to integrate the FASD 

Diagnosis and Intervention program 

within existing service delivery 

organization sites. Using an integrated 

service delivery model all sites are 

screening children using an FASD 

screening tool, obtaining a diagnostic 

evaluation, and providing services/ 

interventions as indicated by the 

diagnostic evaluation. Specific 

interventions are based upon the 

individual child’s diagnosis. Six of the 

sites are integrating the FASD Diagnosis 

and Intervention projects either in a 

child mental health provider setting or 

in a dependency court setting and serve 

children ages 0–7 years. Two of the sites 

are delinquency courts and serve 

children 10–18 years of age. Data 

collection at all sites involves 

administering the screening and 

diagnosis tool, recording process level 

indicators such as type and units of 

service provided; improvement in 

functionality and outcome measures 

such as school performance, stability in 

housing/placement, and adjudication 

measures (10–18 yrs only). Data will be 

collected at baseline, monthly, every six 

months from start of service to end of 

service, at end of intervention, at 6 

months follow-up, and 12 months 

follow-up. 

Estimated Annualized Burden Hours 


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29552 Federal Register / Vol. 75, No. 101 / Wednesday, May 26, 2010 / Notices 

Instrument/Activity Number of 

respondents 

Number of 

responses per 

respondent 

Total number 

of responses 

Average 

burden per 

response 

Total burden 

hours per 

collection 

Client Surveys: Children 0–7: 

Screening and Diagnosis Tool ..................................... 1400 1 1400 0.17 238 

Positive Monitor Tracking ............................................. 450 1 450 0.03 14 

Services Child is Receiving at the time of the FASD 

Diagnosis ................................................................... 750 1 750 0.17 128 

Services Planned and Provided based on Diagnostic 

Evaluation .................................................................. 750 1 750 0.33 248 

Services Delivery Tracking Form ................................. 750 12 9000 0.08 720 

End of Intervention/Program Improvement Measure— 

Case Manager ........................................................... 750 1 750 0.02 15 

End of Intervention/Program Improvement Measure— 

Parent/Guardian ........................................................ 750 1 750 0.02 15 

End of Intervention/Program Customer Satisfaction 

with Service ............................................................... 750 1 750 0.03 23 

Outcome Measures (Children 0–7 years) .................... 750 5 3750 0.08 300 

Lost to follow-up ........................................................... 135 1 135 0.03 4 

Client Surveys: Children 8–18: 

Screening and Diagnosis Tool ..................................... 100 1 100 0.17 17 

Services Child is Receiving at the time of the FASD 

Diagnosis ................................................................... 50 1 50 0.17 9 

Services Planned and Provided based on Diagnostic 

Evaluation .................................................................. 50 1 50 0.33 17 

Services Delivery Tracking Form ................................. 50 12 600 0.08 48 

End of Intervention/Program Improvement Measure— 

Case Manager ........................................................... 50 1 50 0.02 1 

End of Intervention/Program Improvement Measure— 

Parent/Guardian ........................................................ 50 1 50 0.02 1 

End of Intervention/Program Customer Satisfaction 

with Service ............................................................... 50 1 50 0.03 2 

Outcome Measures (Children 8–18 years) .................. 50 5 250 0.08 20 

Lost to follow-up ........................................................... 15 1 15 0.03 1 

TOTAL ................................................................... 7,700 49 19,700 ........................ 1,821 

Written comments and 

recommendations concerning the 

proposed information collection should 

be sent by June 25, 2010 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: May 17, 2010. 

Elaine Parry, 

Director, Office of Program Services. 

[FR Doc. 2010–12643 Filed 5–25–10; 8:45 am] 

BILLING CODE 4162–20–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[60Day–10–09CL] 

Proposed Data Collections Submitted 

for Public Comment and 

Recommendations 

In compliance with the requirement 

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

Paperwork Reduction Act of 1995 for 

opportunity for public comment on 

proposed data collection projects, the 

Centers for Disease Control and 

Prevention (CDC) will publish periodic 

summaries of proposed projects. To 

request more information on the 

proposed project or to obtain a copy of 

data collection plans and instruments, 

call the CDC Reports Clearance Officer 

on 404–639–5960 or send comments to 

CDC Assistant Reports Clearance 

Officer, 1600 Clifton Road, MS D–74, 

Atlanta, GA 30333 or send an e-mail to 

omb@cdc.gov. 

Comments are invited 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) 

ways to enhance 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 the use of 

automated collection techniques or 

other forms of information technology. 

Written comments should be received 

within 60 days of this notice. 

Proposed Project 

Calibration of the Short Strengths and 

Difficulties Questionnaire (SDQ) in the 

National Health Interview Survey 

(NHIS)—New—National Center for 

Health Statistics (NCHS), Centers for 

Disease Control and Prevention (CDC). 

Background and Brief Description 

Section 306 of the Public Health 

Service (PHS) Act (42 U.S.C. 242k), as 

amended, authorizes that the Secretary 

of Health and Human Services (DHHS), 

acting through NCHS, shall collect 

statistics on the extent and nature of 

illness and disability of the population 

of the United States. Section 520 [42 

U.S.C. 290bb–31] of the Public Health 

Service Act, establishes the Center for 

Mental Health Services (CMHS), 


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