Adolescent Family Life Care Program Core Evaluation

ICR 200506-0990-002

OMB: 0990-0290

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
10423
Migrated
ICR Details
0990-0290 200506-0990-002
Historical Active
HHS/HHSDM
Adolescent Family Life Care Program Core Evaluation
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 09/20/2005
Retrieve Notice of Action (NOA) 06/17/2005
Approved per submission of OPHS memo 09/14/05 clarifying incentive structure and revisions to the collection.
  Inventory as of this Action Requested Previously Approved
09/30/2008 09/30/2008
12,600 0 0
6,300 0 0
0 0 0

Adolescent Family Life Care Programs provide services to pregnant and parenting adolescents. The proposed instruments developed for this evaluation permit measurement of standardized core outcomes for parents and their children across sites.

None
None


No

1
IC Title Form No. Form Name
Adolescent Family Life Care Program Core Evaluation

  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 12,600 0 0 12,600 0 0
Annual Time Burden (Hours) 6,300 0 0 6,300 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/17/2005


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