[Federal Register Volume 82, Number 51 (Friday, March 17, 2017)]
[Notices]
[Page 14209]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-05365]


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DEPARTMENT OF DEFENSE

Department of the Army

[Docket ID: USA-2016-HQ-0001]


Proposed Collection; Comment Request

AGENCY: US Army Medical Command, Family Advocacy Program Office, DoD.

ACTION: Notice.

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SUMMARY: In compliance with the Paperwork Reduction Act of 1995, the 
Army Family Advocacy Program Office, US Army announces a proposed 
public information collection and seeks public comment on the 
provisions thereof. Comments are invited on: 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; the accuracy of the agency's estimate of the 
burden of the proposed information collection; ways to enhance the 
quality, utility, and clarity of the information to be collected; and 
ways to minimize the burden of the information collection on 
respondents, including through the use of automated collection 
techniques or other forms of information technology.

DATES: Consideration will be given to all comments received by May 16, 
2017.

ADDRESSES: You may submit comments, identified by docket number and 
title, by any of the following methods:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
     Mail: Department of Defense, Office of the Deputy Chief 
Management Officer, Directorate for Oversight and Compliance, 
Regulatory and Advisory Committee Division, 4800 Mark Center Drive, 
Mailbox #24, Suite 08D09B, Alexandria, VA 22350-1700.
    Instructions: All submissions received must include the agency 
name, docket number and title for this Federal Register document. The 
general policy for comments and other submissions from members of the 
public is to make these submissions available for public viewing on the 
Internet at http://www.regulations.gov as they are received without 
change, including any personal identifiers or contact information.
    Any associated form(s) for this collection may be located within 
this same electronic docket and downloaded for review/testing. Follow 
the instructions at http://www.regulations.gov for submitting comments. 
Please submit comments on any given form identified by docket number, 
form number, and title.

FOR FURTHER INFORMATION CONTACT: To request more information on this 
proposed information collection or to obtain a copy of the proposal and 
associated collection instruments, please write to the U.S. Army 
Medical Command, Health Policy & Services, Behavioral Health Service 
Line, Family Advocacy Program (ATTN: MCHO-CL-H/Ms. Kathleen Foreman), 
2748 Worth Road, JBSA Fort Sam Houston, TX 78234; or call the Point of 
Contact for U.S. Army Medical Command, Family Advocacy Program Office 
at 210-295-7370 or email at [email protected].

SUPPLEMENTARY INFORMATION: 
    Title; Associated Form; and OMB Number: Family Advocacy Program; 
MEDCOM Form 811-Pilot (Behavioral Health Intake-Psychosocial History 
and Assessment); OMB Control Number 0702-XXXX.
    Needs and Uses: The information collection requirement is necessary 
to obtain and record the behavioral/mental health, psychological and 
social history of military health eligible and non-eligible 
beneficiaries in need of domestic violence and child abuse emergency 
and non-emergency support. The form is used by family advocacy workers 
to assess the clinical and non-clinical needs of individuals and 
families to ensure victim safety; reduce the risk of adverse behavioral 
health events like suicide, homicide, accidental death, and physical, 
emotional, and sexual abuse and neglect; refer victims and alleged 
offenders to appropriate treatment and case management resources; to 
gather case information for presentation and incident determination by 
a family advocacy review board; and to gather information for data 
analysis and reporting purposes for overall program improvement.
    Affected Public: Individuals or households.
    Annual Burden Hours: 3,950.
    Number of Respondents: 7,900.
    Responses per Respondent: 1.
    Annual Responses: 7,900.
    Average Burden per Response: 30 minutes.
    Frequency: On occasion.
    Respondents are U.S. citizens (military, civilian, and military-
affiliated civilians; spouses, intimate partners; child care providers; 
teachers) or foreign nationals seeking emergency and non-emergency 
support from military health care facilities, child care facilities, 
and DoD school systems who are seeking domestic violence or child abuse 
support for themselves or their children. MEDCOM Form 811-Pilot records 
the information needed to conduct a thorough and responsible risk 
assessment, behavioral health assessment, treatment plan, and case 
monitoring or management plan. The completed form is included in the 
Family Advocacy Case file and in Family Advocacy System of Records 
(information system). The form is used by family advocacy workers to 
assess the clinical and non-clinical needs of individuals and families 
to ensure victim safety; reduce the risk of adverse behavioral health 
events like suicide, homicide, accidental death, and physical, 
emotional sexual abuse and neglect; refer victims and alleged offenders 
to appropriate treatment and case management resources; to gather case 
information for presentation and incident determination by a family 
advocacy review board; and to gather information for data analysis and 
reporting purposes for overall program improvement. If the form is not 
included in the Family Advocacy file, the records will reflect 
inconsistent risk assessment, behavioral health assessment, treatment 
and management planning. This form is essential to data collection to 
inform treatment and management planning. The form bolsters efforts to 
maintain and document family advocacy worker's compliance with 
standards in the assessment of victims and alleged offenders of abuse. 
In addition, the information gathered supports program improvement and 
risk mitigation.

    Dated: March 14, 2017.
Aaron Siegel,
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 2017-05365 Filed 3-16-17; 8:45 am]
 BILLING CODE 5001-06-P