Parents and Children Together (PACT) Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
PACT - ICR - Baseline+MIS - Supporting Statement B - Rev'd - 10-24-12.docx	Supporting Statement B	Uploaded 2012-10-31	Available
PACT - ICR - Baseline+MIS - Appendix E - Reminders.docx	Supplementary Document	Uploaded 2012-06-20	Available
PACT - ICR - Baseline+MIS - Appendix C - Question Justification_Key Outcome Domains_Surveys Ref.docx	Supplementary Document	Uploaded 2012-06-20	Available
PACT - ICR - Baseline+MIS - Appendix B - Consent Statement October 19.docx	Supplementary Document	Uploaded 2012-10-31	Available
PACT - ICR - Baseline+MIS - Appendix A - Description of Eval Strategies.October 19.docx	Supplementary Document	Uploaded 2012-10-31	Available
PACT - ICR - Baseline+MIS - Supporting Statement A - Rev'd - 10-25-12 (3).docx	Supporting Statement A	Uploaded 2012-10-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202913	New Instrument #3 - Study MIS	Other-MIS	New
202912	New Instrument #2 - Baseline Survey	Other-Survey	New
202911	New Instrument #1b: Introductory Script - Program Applicants	Instruction	New
202910	New Instrument #1a: Introductory Script - Grantee Staff	Other-Script	New
200944	PACT - Discussion Guide	Other-Discussion Guide	Modified

ICR Details

OMB Control No: 0970-0403	ICR Reference No: 201206-0970-012
Status: Historical Active	Previous ICR Reference No: 201201-0970-004
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Parents and Children Together (PACT) Evaluation
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/31/2012
	Date Received in OIRA: 06/27/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2015	36 Months From Approved	04/30/2013
Responses	82,251	0	150
Time Burden (Hours)	4,285	0	150
Cost Burden (Dollars)	0	0	4,401

---

Abstract: This information collection request (ICR) is for clearance to collect information for the Parents and Children Together (PACT) evaluation of a subset of Responsible Fatherhood (RF) and Healthy Marriage (HM) grants authorized under the Claims Resolution Act of 2010 (public law 111-291). Work under PACT will be carried out in stages with different types of information collection in each stage. Thus, requests for clearance will be submitted in stages as work progresses. This ICR requests clearance for an introductory script (to be read to program applicants), baseline instrument, and information to be collected through a study Management Information System (MIS). These three instruments will be used in impact and implementation/qualitative only evaluations of RF programs.

---

Authorizing Statute(s): PL: Pub.L. 111 - 291 403 Name of Law: Claims Resolution Act of 2010
  

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:
	76 FR 78927	12/20/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 38298	06/27/2012
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
PACT - Discussion Guide
New Instrument #1a: Introductory Script - Grantee Staff
New Instrument #1b: Introductory Script - Program Applicants
New Instrument #2 - Baseline Survey
New Instrument #3 - Study MIS

---

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	82,251	150	0	82,101	0	0
Annual Time Burden (Hours)	4,285	150	0	4,135	0	0
Annual Cost Burden (Dollars)	0	4,401	0	-4,401	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This submission is for additional data collection under the Parents and Children Together evaluation and therefore increases total burden under this information collection request.

---

Annual Cost to Federal Government: $3,845,157

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]? 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

---

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: 06/27/2012

---