Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Head of Household Family Interview Advance Letter Evaluation of the Housing Choice Voucher Mobility Demonstration New 180 31 0 Other-Revised - Attachment I Family Interview Advance Letter
Accelerometers (adult) Unchanged 800 135200 0 Other-Accelerometers (adult)
Accelerometers (child) Unchanged 800 135200 0 Other-Accelerometers (child)
Adult Survey Modified 1800 1800 0 Other-Adult Survey
Other-Adult Survey
Other-Adult Survey
Other-Adult Survey
Advance Letter Unchanged 1628 130 0 Other-Advance Letter
Advance Letter Unchanged 2570 206 0 Other-Advance Letter
Anthropometric assessments (adult) Modified 1800 306 0 Other-Anthropometric assessments (adult)
Other-Anthropometric assessments (adult)
Anthropometric assessments (child) Modified 1800 306 0 Other-Anthropometric assessments (child)
Other-Anthropometric assessments (child)
Anthropometric assessments (child, but accounting for parent's time) Unchanged 1800 306 0 Other-Anthropometric assessments (child, but accounting for parent's time)
BASELINE SURVEY New 10100 7575 0 Other-Revised - Instrument 2 HCV Mobility Evaluation Baseline Survey
Blood Pressure Reading (adult) Unchanged 1800 450 0 Other-Blood Pressure Reading (adult)
Blood Spot Samples (adult) Unchanged 1800 306 0 Other-Blood Spot Samples (adult)
COST DATA COLLECTION INTERVIEW GUIDE New 34 68 0 Other-Revised - Instrument 8 Interview Guide for Cost Data Collection
COST STUDY DATA COLLECTION OUTREACH New 34 6 0 Other-Revised - Attachment M Cost Interview Advance Letter
Consent for Assessment Modified 1140 194 0 Other-Consent for Assessment
Other-Consent for Assessment
Consent for Assessment Unchanged 1674 218 0 Other-Consent for Assessment
Consent for Assessment Modified 1800 450 0 Other-Consent for Assessment
Other-Consent for Assessment
Consent for Semi-Structured Interviews Unchanged 75 13 0 Other-Consent for Semi-Structured Interviews
Direct Child Assessment Unchanged 1674 619 0 Other-Direct Child Assessment
Other-Direct Child Assessment
Other-Direct Child Assessment
Direct Measurements Modified 1140 570 0 Other-Direct Measurements
Other-Direct Measurements
Email Reminder Unchanged 2570 51 0 Other-Email Reminder
Email Reminder Unchanged 1628 33 0 Other-Email Reminder
Follow-up Call Phone Script Modified 2570 334 0 Other-Follow-up Call Phone Script
Other-Follow-up Call Phone Script
Follow-up Call Phone Script Modified 1628 212 0 Other-Follow-up Call Phone Script
Other-Follow-up Call Phone Script
HEAD OF HOUSEHOLD FAMILY INTERVIEW CONSENT FORM New 180 45 0 Other-Revised - Attachment H Head of Household Family Interview Consent Form
HEAD OF HOUSEHOLD WAITLIST FAMILY INFORMED CONSENT FOR STUDY PARTICIPATION New 3166 792 0 Other-Revised - Attachment C Head of Household Waitlist Family Informed Consent
Other- Revised - Attachment C Head of Household Waitlist Family Informed Consent
HOUSEHOLD ROSTER AND BASELINE INFORMATION FORM New 10100 7575 0 Other-Revised - Instrument 1 Household Roster and Baseline Information Form_Rev_24August2022
Head of Household Family Interview Email Reminder Evaluation of the Housing Choice Voucher Mobility Demonstration New 180 14 0 Other-Revised - Attachment J Family Interview Email Reminder
Home Observations/ Housing Assessment Unchanged 1800 450 0 Other-Home Observations/ Housing Assessment
INTERVIEW GUIDE FOR OPPORTUNITY AREA LANDLORDS New 36 36 0 Other-Revised - Instrument 7 Interview Guide for Participating Landlords
INTERVIEW GUIDE FOR PARTICIPATING FAMILIES CURRENTLY SEARCHING FOR HOUSING New 90 135 0 Other-Revised - Instrument 5 Interview Guide for Searching Families
INTERVIEW GUIDE FOR PARTICIPATING FAMILIES WHO HAVE LEASED UP New 90 135 0 Other-Revised - Instrument 6 Interview Guide for Leased Up Families
Interviewer Observations Unchanged 1140 194 0 Other-Interviewer Observations
Landlord Interview Advance Letter Evaluation of the Housing Choice Voucher Mobility Demonstration New 72 12 0 Other-Revised - Attachment L Landlord Interview Advance Letter
MOBILITY SERVICES PROVIDERS INTERVIEW GUIDE New 45 68 0 Other-Revised - Instrument 4 Mobility Services Provider Interview Guide
Mobility Services Provider Interview Outreach Evaluation of the Housing Choice Voucher Mobility Demonstration New 45 8 0 Other-Revised - Attachment K Mobility Services Provider Interview Advance Letter
Mobility Services Tracking Tool Evaluation of the Housing Choice Voucher Mobility Demonstration New 45360 9072 0 Other-Revised - Attachment G Mobility Services Tracking Tool
OTHER ADULT HOUSEHOLD MEMBER INFORMED CONSENT FOR STUDY PARTICIPATION New 10100 2525 0 Other-Revised - Attachment D Other Adult Household Member Informed Consent
Other-Revised - Attachment D Other Adult Household Member Informed Consent
PARENT/GUARDIAN PERMISSION FORM New 10100 2525 0 Other-Revised - Attachment E Parent Guardian Permission Form
PHA STAFF INTERVIEW GUIDE New 45 68 0 Other-Revised - Instrument 3 PHA Staff Interview Guide
PHASE 1- HEAD OF HOUSEHOLD EXISTING VOUCHER FAMILY INFORMED CONSENT FOR STUDY PARTICIPATION New 6334 1584 0 Other-Revised - Attachment B Head of Household Existing Voucher Holders Informed Consent
Other-Revised - Attachment B Head of Household Existing Voucher Holders Informed Consent
PHASE 2- HEAD OF HOUSEHOLD EXISTING VOUCHER FAMILY INFORMED CONSENT FOR STUDY PARTICIPATION New 400 100 0 Other-Revised - Attachment N Phase 2 HoH Existing Voucher Holders Informed Consent
Other-Revised - Attachment N Phase 2 HoH Existing Voucher Holders Informed Consent
PHASE 2- HEAD OF HOUSEHOLD WAITLIST FAMILY INFORMED CONSENT FOR STUDY PARTICIPATION New 200 50 0 Other-Revised - Attachment O Phase 2 Head of Household Waitlist Families Informed Consent
Other-Revised - Attachment O Phase 2 Head of Household Waitlist Families Informed Consent
PHASE 2- OTHER ADULT HOUSEHOLD MEMBER INFORMED CONSENT FOR STUDY PARTICIPATION New 5050 1263 0 Other-Revised - Attachment P Phase 2 Other Adult Household Member Informed Consent
Other-Revised - Attachment P Phase 2 Other Adult Household Member Informed Consent
Semi-Structured Interviews Unchanged 75 113 0 Other-Semi-Structured Interviews
Survey Unchanged 1140 285 0 Other-Survey
Other-Survey
Survey about child (asked of parent/guardian) and parent/guardian's presence during direct Child Assessment Unchanged 1674 1256 0 Other-Survey about child (asked of parent/guardian) and parent/guardian's presence during direct Child Assessment
Other-Survey about child (asked of parent/guardian) and parent/guardian's presence during direct Child Assessment
Tracking Calls Unchanged 2700 459 0 Other-Tracking Calls
Tracking Emails/Texts Unchanged 1800 234 0 Other-Tracking Emails/Texts
Total burden requested under this ICR: 144767 313582 0  
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