View Information Collection Request (ICR) Package
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View ICR - Agency Submission
COMMENT
Time Remaining
Days
HR
Min
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OMB Control No:
ICR Reference No:
202512-0970-005
Status:
Received in OIRA
Previous ICR Reference No:
Agency/Subagency:
HHS/ACF
Agency Tracking No:
OPRE
Title:
Personal Responsibility Education Program (PREP) Innovative Strategies (PREIS) Local Evaluation Support: Final Evaluation Report Template
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
Date Submitted to OIRA:
12/18/2025
Requested
Previously Approved
Expiration Date
24 Months From Approved
Responses
6
0
Time Burden (Hours)
240
0
Cost Burden (Dollars)
0
0
Abstract:
The Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services (HHS) seeks approval of the Personal Responsibility Education Program (PREP) Innovative Strategies (PREIS) Local Evaluation Support Final Evaluation Report Template for PREIS grant recipients. PREIS grant recipients are required to carry out local evaluations of their programs and submit a final evaluation report to ACF at the end of their grant. This request includes a template for grant recipients to use to document their evaluation’s analysis and findings. In addition, the information collected in the Final Evaluation Report Template will inform technical assistance provided to grant recipients as they develop the final evaluation reports for ACF to fulfill the grant requirement.
Authorizing Statute(s):
US Code:
42 USC 719
Name of Law: Section 513 of the Social Security Act
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:
90 FR 42249
08/29/2025
30-day Notice:
Federal Register Citation:
Citation Date:
90 FR 59125
12/18/2025
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
PREIS Final Evaluation Report Template & Guidance
1
PREIS Final Evaluation Report Template
ICR Summary of Burden
Total Request
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
6
0
0
6
0
0
Annual Time Burden (Hours)
240
0
0
240
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
This is a new information collection.
Annual Cost to Federal Government:
$57,593
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?
No
Agency Contact:
Molly Buck 202 205-4724 mary.buck@acf.hhs.gov
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:
12/18/2025
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