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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Multi-Site Study of State-Tribal Collaboration in Home Visiting
Agency IC Tracking Number:
OPRE
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Interview Protocol
Instrument A - MUSE-STC Interview Protocol_OMB_clean_fnl.docx
Yes
Yes
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
42
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
42
0
0
0
0
42
Annual IC Time Burden (Hours)
63
0
0
0
0
63
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA Prog Supp GenIC - Multi-Site Study of State-Tribal Collaboration in Home Visiting
Generics Supporting Statement A - MUSE-STC_OMB_clean_OMB.docx
06/22/2022
SSB Prog Supp GenIC - Multi-Site Study of State-Tribal Collaboration in Home Visiting
Generics Supporting Statement B - MUSE-STC_OMB_clean.docx
06/22/2022
APPENDIX A: Draft Recruitment Email and Call Script
Appendix A - MUSE-STC Draft Interview Recruitment Email and Phone Script_OMB.docx
06/03/2022
APPENDIX B: Draft Study Notification Email from Health Resources and Services Administration
Appendix B -Study Notification Email from Health Resources and Services Administration_OMB_clean.docx
06/03/2022
APPENDIX C: MUSE-STC Site Engagement Email
Appendix C - MUSE-STC Site Engagement Email_OMB.docx
06/03/2022
APPENDIX D: MUSE-STC Research Flyer
Appendix D - MUSE-STC research flyer_OMB_clean.docx
06/03/2022
APPENDIX E: MUSE-STC Consent Form
Appendix E - MUSE-STC Consent Form_OMB_clean.docx
06/03/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.