Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Outcomes and impacts data - Standardized instruments: Data entry for comparison study sites (16 grantees) (Appendix G) Modified 3400 2125 0 Other-Data Elements
Enrollment and services data: Case closure (Appendix F) Modified 3564 59 0 Other-Data Elements
Enrollment and services data: Case closure – prenatal (Appendix F) Modified 360 6 0 Other-Data Elements
Enrollment and services data: Case enrollment data (Appendix F) Modified 3564 891 0 Other-Data Elements
Enrollment and services data: Semiannual progress reports (Appendix E) Modified 72 1188 0 Other-Progress Report
Enrollment and services data: Service log entries (Appendix F) Modified 336960 11232 0 Other-Data Elements
Outcomes and impacts data - Administrative data: Obtain access to administrative data (Appendix H) Modified 36 1482 0 Other-Admin Data
Outcomes and impacts data - Administrative data: Report administrative data (Appendix H) Modified 72 10368 0 Other-Admin Data
Outcomes and impacts data - Standardized instruments: Enter data into local database (Appendix G) Modified 3600 2250 0 Other-Data Elements
Outcomes and impacts data - Standardized instruments: Review records and submit (Appendix G) Modified 72 1800 0 Other-Data Elements
Site visit and key informant data collection: Frontline staff interviews (Appendix B) Modified 17 17 0 Other-Interview
Site visit and key informant data collection: Partner representative interviews (Appendix B) Modified 26 26 0 Other-Interview
Site visit and key informant data collection: Partner survey (Appendix C) Modified 44 18 0 Other-Survey
Site visit and key informant data collection: Program director individual interview (Appendix B) Modified 9 17 0 Other-Interview Guide
Site visit and key informant data collection: Program manager/supervisor individual interviews (Appendix B) Modified 9 9 0 Other-Interview
Site visit and key informant data collection: Sustainability survey (Appendix D) Modified 106 35 0 Other-Survey
Total burden requested under this ICR: 351911 31523 0  
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