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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Touchpoints for Addressing Substance Use Issues in Home Visiting: Performance Measurement Pilot
Agency IC Tracking Number:
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-Reporting Tool
Instrument 1_SUD1 and SUD2 Measures Reporting Tool.xlsx
Yes
Yes
Fillable Fileable
Other-Interview Protocol
Instrument 2_Interview Protocol_State Awardees.docx
No
Paper Only
Other-Interview Protocol
Instrument 3_Interview Protocol_LIA Managers and Data Managers, Home Visiting Supervisors, and Home Visitors.docx
No
Paper Only
Other-Interview Protocol
Instrument 4_Interview Protocol_Home-Visiting-Model Representatives.docx
No
Paper 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:
56
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
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
87
0
0
0
0
87
Annual IC Time Burden (Hours)
73
0
0
0
0
73
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement A - Touchpoints Pretesting GenIC
Generic SSA_Touchpoints_Pretesting.docx
05/18/2021
Supporting Statement B - Touchpoints Pretesting GenIC
Generic SSB_Touchpoints_Pretesting.docx
05/18/2021
Appendix A_Pilot Study FAQs
Appendix A_Pilot Study FAQs.docx
05/18/2021
Appendix B_Invitations to Participate in the Study
Appendix B_Invitations to Participate in the Study.docx
05/18/2021
Appendix C_Research Questions Addressed by Interview Protocols
Appendix C_Research Questions Addressed by Interview Protocols.docx
05/18/2021
NOA - Touchpoints Pretesting GenIC
NOA - Pretesting_Touchpoints GenIC_3.20.21.pdf
05/18/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.