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:
201801-0970-013
Status:
Historical Active
Previous ICR Reference No:
201706-0970-005
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:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
05/11/2018
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/22/2018
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2021
36 Months From Approved
05/31/2018
Responses
44,124
0
44,124
Time Burden (Hours)
17,062
0
17,062
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:
82 FR 54345
11/17/2017
30-day Notice:
Federal Register Citation:
Citation Date:
83 FR 6025
02/12/2018
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
115
IC Title
Form No.
Form Name
2018 ANA Grantee Meeting Pre-Survey
1
Grantee Meeting Pre-Survey
2018 ANA Grantee Meeting Survey
1
ANA GM - Blank Survey Form
2019 Low Income Home Energy Assistance Program (LIHEAP) Grantee Conference Feedback
2019 National Runaway and Homeless Youth (RHY) Grantees Training Evaluations
2019 Reader Feedback: Brush Up on Oral Health
2019 Youth Summit Committe Planning Survey
1
ILIAD 2019 Youth Summit Planning Committee Survey
2020 ACF Native American Grantee Meeting Survey
2020 ACF Tribal Peer-to-Peer Grantee Meeting Survey
ACF Office of Regional Operations Curstomers Feedback for Learning Experiences
1
ORO Webinar or Meeting Feedback Survey
ACF State and County Human Services Commissioner Surveys
ANA Youth Summit Survey
1
2018 I-LEAD Youth Summiot Survey
Administration for Native Americans (ANA) 2020 Discretionary Application Process and Peer Panel Review Surveys
Administration for Native Americans (ANA) 2020 Initiative for Leadership, Empowerment and Development (I-LEAD) Youth Webinar Series Surveys
Administration for Native Americans (ANA) Application Submission Process Feedback Survey
Administration for Native Americans (ANA) Post Peer Panel Review Survey
Adolescent Pregnancy Preventing Training & Technical Assistance
1
Attachment 1-Survey
Adolescent Pregnancy Prevention Training & Technical Assistance 2019 Conference Feedback Surveys
Adolescent Pregnancy Prevention Training & Technical Assistance 2020 Conference Feedback Surveys
Audience Research for Sexual Risk Avoidance (SRA) Social Media Marketing Campaign
1, 1, 1
Attachment 1
,
CTK Parent Consent Form
,
CTK Youth Assent Form
Building Evidence Training (BET) Project Usability Testing
CCDF Administrator Feedback Collection
1
CCDF Administrators
Center for States 2020 Needs Assessment Survey
Center for States Needs Assessment Focus Group
Center for States Subscription Form
Child Care Development Block Grant (CCDBG) Implementation Research Webinar Feedback Poll
Child Care Development Block Grant (CCDBG) Implementation Research and Evaluation Grantees - Meeting Evaluation Form
Child Care Development Block Grant (CCDBG) National Webinar Feedback Poll
Child Care and Development Block Grant (CCDBG) Implementation Research and Evaluation Grantees - Meeting Evaluation Form
Child Care and Development Fund (CCDF) Policies Database Pop-Up Survey of Website Users
Child Welfare Capacity Building Collaborative Customer Feedback for Webinars and Events
Child Welfare Information Gateway Needs Assessment Focus Group Guide
Child Welfare Information Gateway Prevention Resource Guide Tip Sheet Feedback Form
Child Welfare Information Gateway Subscription Form
Child Welfare Information Gateway's Customer Satisfaction Assessment
1
CWIG Customer Satisfaction Assessment Data Collection Instruments
Child Welfare Program Improvement Plan Pilot Evaluation
1, 1, 1, 1
PIPPilot
,
PIPPilot
,
PIPPilot Onsite Feedback Survey
,
PIPPilot PreonsiteFeedbackSurvey
Children's Bureau Grantee Connection Survey
Children's Bureau Grantee Feedback Survey
Coaching Companion Questionnaire
Comment Form: Fatherhood Research and Practice Netrwork Learning Community
FRPN Feedback Instrument
FRPN Feedback Instrument
Comment Form: 2018 OPRE Innovative Methods Meeting.
Comment Form: 2019 OPRE Innovative Methods Meeting.
Communities of Practice
1
Communities of Practice
Community Economic Development (CED) Grantee Training Needs Assessment
Community Economic Development (CED) or Rural Community Development (RCD) Grantee Discussion Groups
Course Participant Knowledge Gain Assessment and Instructior and Course Participant Experimental Feedback
36, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1
EBPAS-36
,
Instructior Experience Survey Final
,
Instructor Unit Survey Final
,
Participant Experience Survey Final
,
Unit 1 Post Test Final
,
Unit 2 Post-Test Final
,
Unit 2 Pre-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
ECTTAS Coordination Survey
1
ECTTAS Coordination Survey
Evaluation of Family Violence Prevention and Services Act (FVPSA) Regional Meeting
Evidence-Building Academy Participant Project Introduction
FY2019 New Capacity Building Center for States Community of Practice: County Administered State Support Interest Survey
Family Violence Prevention and Services (FVPSA) 2019 Tribal Grantee Meeting
Family Violence Prevention and Services (FVPSA) 2020 Tribal Grantee Meeting
Feedback Colection for Peer Leaning
1
Peer Learning
Feedback Survey for Human Trafficking webinars, online training, online sessions hosted by the Family and Youth Services Bureau
Feedback Survey for Technical and Training Assistance Activities for Family and Youth Services Bureau/ Runaway and Homeless Youth grantees
Feedback Survey for capacity building, grantee, training, online sessions hosted by the Family and Youth Services Bureau
Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2019 Annual Meeting
Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2020 Annual Meeting
Feedback on Child Care and Development Fund Plan for States/Territories for FFY 2019–2021 (ACF–118)
Feedback on Mixed-Delivery System and Service Coordination to Inform Appropriate, Tailored and Timely Technical Assistance
Feedback on National Center on Parent, Family and Community Engagement (NCPFCE) Resources
Feedback on Strategies Related to Opioid Misuse
1
Feedback Form on Strategies Related to Opioid Misuse
Feedback on Webinars for Data Use and General Info for the National Survey of Early Care and Education (NSECE)
Focus Group with Healthy Marriage and Relationship Education (HMRE)
1
SARHM generic OMB
Grant Review Panel Chair Development Training
Grantee Exchange Platform Survey
Grantee Feedback for the FVPSA Formula Grantee Meeting Planning
HSICC Post Phone Call Survey
1
Post Phone Calll Survey
Head Start Management Fellows (HSMF) Program Feedback Surveys
In-Person Convening Child Care Policy Research Partnership - Participant Feedback
In-Person Convening Child Care Policy Research Partnership – Participant Feedback
Infant Toddler Spcialist Infividualized Technical Assistance
1
Infant Toddler Specialist Individualized Technical Assistance
Infant Toddler Specialist Network Training for Trainers (TFT)
1
Traininging for Training
Infant Toddler Specialist Presentation
1
Infant Toddler Specialist Presentations
Information Architecture Testing of the Early Childhood Learning and Knowledge Center
1
ECLKC-tree-jack survey instrument
Input on Key Functions of Early Care and Education Research Connections Website
Leadership Initiative Feedback Surveys
Listening Session Questions on OHS Training and Technical Assistance System
Maternal, Infant, and Early Childhood Home Visiting (MEICHV) Continuous Quality Improvement
1
MIECHV
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) AGM 2019 – Peer Sharing Feedback Survey
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) AGM 2019 – Peer Sharing Feedback Survey
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) TA Satisfaction Survey
1
DOHVE 2
Maternal, Infant, and Early Childhood Home Visiting All Grantee & Tribal Regional Meetings Feedback Tools
National Center on Early Childhood Health and Wellness (NCECHW) Infoline Feedback Form
National Responsible Fatherhood Clearinghouse User Feedback and Content
National Youth in Transition Database (NYTD) Technical Assistance Utilization and Needs Survey
New Director Mentor Program (NDMP) Feedback Surveys
OFA TANF TA Convening Individual Session Assessment
1
OFA Convening Individual Assessment
OFA TANF TA Convening Overall Evaluation Assessment
1
OFA Convening Overall Assessment
OHS TTA Network Training Feedback Form
1
TTA Network Training Feedback
Office of Family Assistance PeerTA website Evaluation and Satisfaction Survey
Office of Refugee Resettlement (ORR) Refugee Programs Training and Technical Assistance Evaluation
Peer-Based Technical Training and Technical Assistance Feedback Collection Activities
Personal Responsibility Education Program (PREP) Grantee Training and Technical Assistance Satisfaction and Needs Assessment
Poll questions for a National Runaway Safeline (NRS) webinar for grantees
Program Management and Fiscal Operations (PMFO) Consulting Initiative (FCI) Feedback Surveys
Program Management and Fiscal Operations (PMFO) Feedback Survey about the General Business Studies Certificate.
Program Management and Fiscal Operations (PMFO) Feedback Surveys
Program Management and Fiscal Operations (PMFO) Hurricane Response and Recovery (HRR) Feedback Survey.
Public Assistance Reporting Information System (PARIS) Training Conference Post Event Survey
Region XII MSHS T/TA Network Technical Assistance Services Delivery Feedback
1
Region-XII-TTA Feedback Form
Region XII Migrant and Seasonal Head Start T/TA Service Deloivery Feedback
1
Service Delivery Feedback Form OHS Region 12
Regorous Evaluation Technical Assistance (RETA) Feedback Form
1
RETA-Feedback Form
Runaway and Homeless Youth (RHY) Program Virtual Town Halls (Interactive Polling Questions)
Runaway and Homeless Youth (RHY) Regional Meeting Evaluation
Runaway and Homeless Youth (RHY) Regional Meeting Evaluation
Sexual Risk Avoidance (SRA) Social Media Marketing Campaign
1
Social Norms Quiz
Sexual Risk Avoidance (SRA) Social Media Marketing Campaign
1, 1, 1, 1, 1
Attachment 1 Discussion Prompts
,
CTK Parent Consent Form
,
CTK Youth Assent Form
,
Display
,
Youth Assent Form The Hive
Sexual Risk Avoidance Education (SRAE) Grantee Needs Assessment
Sexual Risk Avoidance Education (SRAE) Grantee Training and Technical Assistance Satisfaction Survey
Sexual Risk Avoidance Education (SRAE) Grantee Webinar Satisfaction Survey
State Capacity Building Center Tailored TA Feedback Collection for Impact Project
1
OCC OMB SCBC Task 4 Impact Instrument
TA Assistance Feedback Collection for Webinars
1
Task 3 Webinars
Tribal Home Visiting Technical Assistance Evaluation Feedback and Immediate Feedback Forms
Usability testing for the "Pathways to Work Evidence Clearinghouse" website
nFORM Help Desk Customer Service Feedback Surveys
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
44,124
0
0
0
0
Annual Time Burden (Hours)
17,062
17,062
0
0
0
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
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
No
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
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:
02/22/2018
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