View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View Generic ICR - OIRA Conclusion
OMB Control No:
0970-0401
ICR Reference No:
201706-0970-005
Status:
Historical Active
Previous ICR Reference No:
201705-0970-010
Agency/Subagency:
HHS/ACF
Agency Tracking No:
OPRE
Title:
Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
07/05/2017
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/29/2017
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2018
05/31/2018
05/31/2018
Responses
44,124
0
14,124
Time Burden (Hours)
17,062
0
7,062
Cost Burden (Dollars)
0
0
0
Abstract:
This is a generic request to seek feedback from the public on service delivery. This is in accordance with the Administrations's commitment to improving service delivery.
Authorizing Statute(s):
PL:
Pub.L. 110 - 134 125
Name of Law: Head Start Act of 2007
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
79 FR 69492
11/21/2014
30-day Notice:
Federal Register Citation:
Citation Date:
80 FR 3606
01/23/2015
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
76
IC Title
Form No.
Form Name
ACF Office of Regional Operations Customer Feedback for Learning Experiences
AFI Capacity Building Toolkit Usability Test
1
Fast Track Toolkit Survey Instrument
AFI Capacity Building Visit
1
AFI Capacity Building Visit Feedback Form
AFI Grantee Workshop Evaluation Survey
1
Grantee Workshop Survey Instrument
AFI Outreach Survey
1
AFI Outreach Assessment
ANA 2016 Communication Survey
1
ANA Comms Survey Questions Survey Monkey
ANA Language Summit Survey
ANA Post Peer Panel Review Survey
1
ANA Survey
ANA Sustainablility Servicers Survey
1
3 Year Posst Project Survey
ANA Training and Technical Assistance Services Survey
1
ANA TTA Survey Questions
Adoption Triad Survey
1
Adoption Triad
BICS Vermont Grant Resolution Meeting Customer Satisfaction
1
VT BICS Draft Questionaire 2-8-16
CWCB CapLEARN
1
CapLearn registration fields
CWIG Virtual Conference Exit Survey
1
Exit Survey
Capacity Building Collaborative Customer Feedback for Learning Experiences
1
Capacity Building Collaborative Customer Feedback Instrument
Center for States
1
Center for States Intensive Capacity Building Project
Center for States - 2015
1
Center for States Needs Assessment Survey 2016
Center for States Media Consumption Survey
1
Media Consumption Survey Instrument
Center for States Needs Assessment 2017
Center for Urban Families (CFUF)
1
National Responsible Fatherhood Clearinghouse (NRFC)
Child Welfare Capacity Building Collaborative Focus Group
1
VirtualConference FocusGroupGuide
Child Welfare Information Gateways's Special Inititative Survey
1
CWIG Special Inititiative Survey for OMB 1-20-16
Collaborative Customer Feedback
1
Capacity Building Collaborative Customer Feedback Instrument
Comment Form: 2015 OPRE Innovative Methods Meeting
Comment Form: Fatherhood Research and Practice Network Learning Community
Constituency Group Survey
1
Fast Track Instrument
Course Participant Knowledge Gain Assessment
1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1
EBPAS-36
,
Instructor Experience Survey Final
,
Instructor Unit Survey
,
Instructor Unit Survey Final
,
Participant Experience Survey Final
,
Unit Post Test Final
,
Unit 2 Post Test Final
,
Unit 2Pre Test Final
,
Unit 3 Post-Test Final
,
Unit 3 Pre Test Final
,
Unit 4 Post-Test Final
,
Unit 4 Pre Test Final
,
Unit 5 Post Test Final
,
Unit 5 Pre Test Final
,
Unit 6 Post-Test Final
,
Unit 6 Pre Test Final
Customer feedback focus group with Healthy Marriage and Relationship Education (HMRE) program staff
FEI Focus Group
1
Focus Group
FEI Website Survey
1
FEI Website Survey
Father Involvement Communication Checks
1
Fatherhood Screener Comm Check
Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2017 Annual Meeting
Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2018 Annual Meeting
Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinar
Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinars 3&4
Feedback on Mother and Infant Home Visiting Program Evaluation (MIHOPE) Long-term Follow-up study design options
Feedback on the "Looking forward to the 2019 National Survey of Early Care and Education" webinar
Follow-Up Needs Assessment Feedback Form
1
Follow-up Needsw Assessment Feedback Form
HS-ECLKC Tree Testing
1
ECLKC Tree Testing Script
Human Trafficking Data Collection Pilot
1, 1
OTIP DCP Survey Questionnaire
,
DCP Stakeholder Interview Guide
Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting
Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting
Input on Agenda for 2017 Annual Meeting of Child Care and Early Education Policy Research Consortium
Institute Feedback Form
1
Institute Feedback Form
Investigation and Analysis of AFI
1
AFI Outreach Instruments
MIECHV Grantee Feedback on Data and Evaluation Technical Assistance
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Continuous Quality Improvement (CQI) Practicum Feedback Questions
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) TA Satisfaction Survey
Meeting Evaluation Form - CCDBG Implementation Research and Evaluation Planning Grantees
National Foster Care and Adoption Directory Survey
1
NFCAD Survey
National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms
1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1
Consultant
,
Coordination
,
FG Demographic Survey
,
FocusGroupGuide
,
Followup
,
GeneralTraining
,
Interview Guide
,
Pilot
,
RequesterFeedback
,
ResourceTool
,
SOAR Blended Learning Participant Form
,
SOAR Conference
,
SOAR Online Participant Form
,
SOAR Organizational Feedback
,
SOAR SpcializedTTA
,
WebinarParticipant
OAS-Administrator Feedback Collection
1
Administrator Feedback Collection
OAS-On-Site Meeting Facilitation State Feedback Collection
1
Meeting Facilitation
OAS-Specialized Resources TA Feedback Collection
1
SCBC Task 2
OAS-TA Feedback Collection for Infant Toddler
1
SCBC Task 3
OAS-TA State Systems Specialist Network Feedback
1
TA State Systems Network Feedback
OCS CED Focus Group
1
CED Grantee Needs Assessmenr
OCS-AFI Application Readiness Assessment Questions for Cohert Participants
1
AFI Instruction and Instruments.
OHS TTA Network Training Feedback Form
1
Feedback Form
OHS-Conference Feedback Survey
1
PMFO Conference Survey
OHS-Event Session Survey
1
Event Session Survey
OHS-Fiscal Consulting Survey
1
Fiscal Consulting Survey
OTIP
1
OTIP Fast Track Request
OTIP NHTTAC General Fast Track
1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1
Advisory Committee Feedback
,
Call Center Feedback
,
Conference Session Feedback
,
General Conference Feeback
,
HTFellowship POST Program
,
HT Fellowship PREP Program
,
OTIP Grantee Feedback
,
Scholarship Applicant Org
,
ScholarshipAoplicant
,
Short Term TTA Feedback
,
Specialized TTA Feedback
,
Survivor Fellow Feedback
,
Survivor Fellow Feedback
,
Website Feedback
PMFO Fiscal Consulting Inititative Feedback Survey
1
PMFO Fiscal Consulting Survey
PMFO New Director Mentor Iniative
1
NDMI Live Learning Event Survey
Participant Feedback Form for the CCDBG Implementation Research and Evaluation Planning Grantee Community of Practice Meeting
Region XII Migrant and Seasonal Head Start T/TA Service Delivery Feedback
1
Service Delivery Feedback Form
Regugee Health Coordinator Survey
1
Survey of Refugee Health Coordinators
Rigorous Evaluation Technical Assistance (RETA) Feedback Form
SOAR End of Course Evaluation
1
Justification
SOAR Human Trafficking Training End-of-Course Evaluation
1
SOAR End-of-Course Evaluation
Soliciatation of Opinions for 2017 ACF Native American Grantee Meeting
1
IC for 2017 ACF Grantee Meeting
Special Initiative Survey
1
Special Initiative Survey
Tribal MIECHV Data System Planning
Virtual Conference Session Evaluation
1
Generic Request
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
44,124
14,124
0
0
30,000
0
Annual Time Burden (Hours)
17,062
7,062
0
0
10,000
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$1,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Robert Sargis 2026907275
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
06/29/2017
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