View Information Collection (IC)
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Family Level Assessment and State of Home Visiting (FLASH-V)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Assessment Form 1 - Eligibility Assessment Form.xlsm Yes Yes Fillable Fileable
Other-Outreach 2 - Outreach to LIAs and CIs, Assessing Eligibility, and Scheduling Interviews.docx Yes Yes Fillable Fileable
Other-Interview Protocol 3 - Interview Protocol_LIA.docx No   Paper Only
Other-Interview Protocol 4 - Interview Protocol_Centralized Intake Agency.docx No   Paper Only

Community and Social Services Social Services

 

118 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 118 0 118 0 0 0
Annual IC Time Burden (Hours) 57 0 57 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Appendix A - Outreach to State Grantees Appendix A - Outreach to State Grantees.docx 03/28/2018
Appendix B - Project Description Appendix B - Project Description.docx 03/28/2018
Appendix C - Informed Consent Appendix C - Informed Consent.docx 03/28/2018
SSA - FLASHV Formative FLASH-V SSA Template - Formative Generics 010918.doc 03/28/2018
SSB - FLASHV FLASH-V SSB Template - Formative Generics 010918.doc 03/28/2018
NOA - FLASHV Generic FLASH-V Formative_NOA_1.19.18.pdf 03/28/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.