Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Home Visitor Survey Baseline Unchanged 160 200 0 Other-Survey
Supervisor Survey 12 Month Unchanged 23 29 0 Other-Survey
Child and Family Outcome Survey and Updating Contact Information Unchanged 4299 2150 0 Other-Check-In
Other-Check-in
Combined Home Visitor - Supervisor Baseline Survey Unchanged 10 18 0 Other-Survey
Combined Home Visitor-Supervisor 12 Month Survey Unchanged 10 18 0 Other-Survey
Community Service Provider Survey Unchanged 510 51 0 Other-Survey
Direct Child Assessments Unchanged 1445 1156 0 Other-Protocol - Child assessments
Direct parent-child interaction Unchanged 2890 1734 0 Other-Protocol - parent-child interaction
Family Baseline Survey Unchanged 1700 1700 0 Other-Survey
Family Screening and Consent Unchanged 1889 189 0 Other-Screener
Family follow-up survey Unchanged 1445 1445 0 Other-Survey
First Round Visits with State Administrators Unchanged 18 27 0 Other-Site Visits
Home Visitor Group Interview 12 Month Unchanged 57 86 0 Other-Interview
Home Visitor Individual Interview 12 Month Unchanged 57 86 0 Other-Interview
Home Visitor Logs Unchanged 10200 2040 0 Other-Logs
Other-Logs revised
Home Visitor Logs - Past 15 months Unchanged 8500 765 0 Other-Logs
Home Visitor Survey 12 Month Unchanged 160 200 0 Other-Survey
Measuring Height and Weight Unchanged 2890 289 0 Other-Protocol - Child assessments
Other Home Visiting Programs Survey Unchanged 142 14 0 Other-Survey
Program Manager Group Interview 12 Month Unchanged 29 44 0 Other-Interview
Program Manager Survey 12 Month Unchanged 29 58 0 Other-Survey
Program Manager Survey_Part 1 Baseline Unchanged 29 15 0 Other-Survey
Program Manager Survey_Part 2 Baseline Unchanged 29 29 0 Other-Survey
Program Manager Survey_Part 3 Baseline Unchanged 29 29 0 Other-Survey
Second Round Visits with State Administrators Unchanged 15 23 0 Other-Site Visits
State Administrator Interview 12 Month Unchanged 8 16 0 Other-Interview
State Administrator Interview Baseline Unchanged 8 16 0 Other-Interview
Supervisor Group Interview 12 Month Unchanged 33 50 0 Other-Interview
Supervisor Logs Unchanged 1980 396 0 Other-Logs
Supervisor Survey Baseline Unchanged 23 29 0 Other-Survey
Telephone contact with state administrators Unchanged 49 49 0 Other-Telephone Contact
Visits and Calls with Local Program Directors Unchanged 120 360 0 Other-Visits and Calls
Total burden requested under this ICR: 38786 13311 0  
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