Information Collection

Head Start Family Voices Pilot Study

IC 205972 under ICR 201110-0970-002 · OMB 0970-0355.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0355 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
A1a. Program Recruitment Script.docx	Other-Script
A1b. Program Recruitment Screener.docx	Other-Screener
A2. Participant Recruitment Form.docx	Other-Recruitment Form
A3. Parent Qualitative Interview Protocol - All Modules.docx	Other-Protocol
A6. Staff Questionnaire.docx	Other-Questionnaire
A5. Parent Questionnaire.docx	Other-Questionnare
A4. Staff Qualitative Interview Protocol - All Modules.docx	Other-Protocol
HSFV Supporting Statement A 2-26-13 FINAL.docx HSFV Supporting Statement A 2-26-13 FINAL	IC Document
HSFV Supporting Statement B 2-26-13 FINAL.docx HSFV Supporting Statement B 2-26-13 FINAL	IC Document
Attachments-FINAL.docx Attachments-FINAL	IC Document
B1-B2-B3-C1-combined.docx B1-B2-B3-C1-combined	IC Document

IC Title:

Head Start Family Voices Pilot Study

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Script	A1a. Program Recruitment Script.docx	Yes	Yes	Fillable Fileable
Other-Screener	A1b. Program Recruitment Screener.docx	Yes	Yes	Fillable Fileable
Other-Recruitment Form	A2. Participant Recruitment Form.docx	Yes	Yes	Fillable Fileable
Other-Protocol	A3. Parent Qualitative Interview Protocol - All Modules.docx	Yes	Yes	Fillable Fileable
Other-Questionnaire	A6. Staff Questionnaire.docx	Yes	Yes	Fillable Fileable
Other-Questionnare	A5. Parent Questionnaire.docx	Yes	Yes	Fillable Fileable
Other-Protocol	A4. Staff Qualitative Interview Protocol - All Modules.docx	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 380

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	380	0	0	0	0	0
Annual IC Time Burden (Hours)	341	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HSFV Supporting Statement A 2-26-13 FINAL	HSFV Supporting Statement A 2-26-13 FINAL.docx	02/26/2013
HSFV Supporting Statement B 2-26-13 FINAL	HSFV Supporting Statement B 2-26-13 FINAL.docx	02/26/2013
Attachments-FINAL	Attachments-FINAL.docx	02/26/2013
B1-B2-B3-C1-combined	B1-B2-B3-C1-combined.docx	02/26/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.