Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Enrollment and services data: Case closure (Appendix E) New 3483 70 0 Other-Data Elements
Enrollment and services data: Case closure – prenatal (Appendix E) New 2673 54 0 Other-Data Elements
Enrollment and services data: Case enrollment data (Appendix E) New 3483 871 0 Other-Data Elements
Enrollment and services data: Semiannual progress reports (Appendix D) New 54 891 0 Other-Progress Report
Enrollment and services data: Service log entries (Appendix E) New 370656 11120 0 Other-Data Elements
Outcomes and impacts data - Administrative data: Obtain access to administrative data (Appendix G) New 27 1150 0 Other-Admin Data
Outcomes and impacts data - Administrative data: Report administrative data (Appendix G) New 54 7776 0 Other-Admin Data
Outcomes and impacts data - Standardized instruments: Data entry for comparison study sites (Appendix F) New 2860 3575 0 Other-Data Elements
Outcomes and impacts data - Standardized instruments: Data entry for standardized instruments (Appendix F) New 3510 4388 0 Other-Data Elements
Outcomes and impacts data - Standardized instruments: Review and adopt reporting templates (Appendix F) New 9 72 0 Other-Data Elements
Outcomes and impacts data - Standardized instruments: Review records and submit (Appendix F) New 54 1350 0 Other-Data Elements
Site visit and key informant data collection: Frontline staff interviews (Appendix B) New 14 14 0 Other-Interview
Site visit and key informant data collection: PD/PM phone interview (Appendix B) New 4 4 0 Other-Interview
Site visit and key informant data collection: Partner representative interviews (Appendix B) New 21 21 0 Other-Interview
Site visit and key informant data collection: Partner survey (Appendix C) New 45 19 0 Other-Survey
Site visit and key informant data collection: Program director individual interview (Appendix B) New 7 14 0 Other-Interview Guide
Site visit and key informant data collection: Program manager/supervisor individual interviews (Appendix B) New 7 7 0 Other-Interview
Total burden requested under this ICR: 386961 31396 0  
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