Hispanic Healthy Marriage Initiative Grantee Implementation Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
HHMI - Focus Group Consent Form.DOC	Supplementary Document	Uploaded 2009-06-22	Available
HHMI - Individual-Small Groups Consent Form.DOC	Supplementary Document	Uploaded 2009-06-22	Available
Fiinal Part B OMB Supporting Statement 12-1-08.DOC	Supporting Statement B	Uploaded 2008-12-11	Available
HHMI - Revised OMB Supporting Statement Part A.DOC	Supporting Statement A	Uploaded 2009-06-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
187746	Discussion Guide for Staff from Service Delivery Partners	Other-Hispanic Healthy Marriage Initiative Grantee Implementatio	New
187745	Discussion Guide for Facilitators	Other-Hispanic Healthy Marriage Initiative Grantee Implementatio	New
187744	Discussion Guide for Program Evaluators	Other-Hispanic Healthy Marriage Initiative Grantee Implementatio	New
187743	Discussion Guide for Program Directors	Other-Hispanic Healthy Marriage Initiative Grantee Implementatio	New
187742	Discussion Guide for Other Program/Data Staff	Other-Hispanic Healthy Marriage Initiative Grantee Implementatio	New
187741	Discussion Guide for Community Leaders	Other-Hispanic Healthy Marriage Initiative Grantee Implementatio	New
187740	Discussion Guide for Executive Directors	Other-Hispanic Healthy Marriage Initiative Grantee Implementatio	New
187739	Discussion Guide for Focus Groups with Participants	Other-Healthy Marriage Initiative Grantee Implementation Evaluat	New

ICR Details

OMB Control No: 0970-0367	ICR Reference No: 200901-0970-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Hispanic Healthy Marriage Initiative Grantee Implementation Evaluation
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/06/2009
	Date Received in OIRA: 01/07/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2012	36 Months From Approved
Responses	324	0	0
Time Burden (Hours)	450	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Hispanic Healthy Marriage Initiative (HHMI) Grantee Implementation Study will provide documentation and lessons about diverse programmatic approaches to improve Hispanic family well-being through healthy marriage education programs. This submission seeks clearance for information collection protocols that will be used to obtain information about the ways in which healthy marriage grantees are developing, adapting, and implementing culturally relevant and appropriate healthy marriage programs for Hispanic populations.

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Authorizing Statute(s): US Code: 42 USC 1310 Name of Law: COOPERATIVE RESEARCH OR DEMONSTRATION PROJECTS
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 36088	06/25/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 78370	12/22/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Discussion Guide for Focus Groups with Participants
Discussion Guide for Executive Directors
Discussion Guide for Community Leaders
Discussion Guide for Other Program/Data Staff
Discussion Guide for Program Directors
Discussion Guide for Program Evaluators
Discussion Guide for Facilitators
Discussion Guide for Staff from Service Delivery Partners

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ICR Summary of Burden

table that charts list 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	324	0	0	324	0	0
Annual Time Burden (Hours)	450	0	0	450	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 data collection.

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Annual Cost to Federal Government: $341,399

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 01/07/2009

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