Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Assessment Protocol	Form and Instruction	New	Available
Form 1 2015 Grantee Meeting Survey	Form and Instruction	New	Available
Form 1 Fatherhood Discussion Guide	Form and Instruction	New	Available
Form 1 Father Screener	Form and Instruction	New	Available
Form 1 Service Improvement Interview Protocol	Form and Instruction	New	Available
Form 1 Satisfaction Assessment	Form and Instruction	New	Available
Form 1 Revised UCinn survey	Form and Instruction	New	Available
Form 1 Customer Satisfaction Sruvey	Form and Instruction	New	Available
Form 1 General Customer Survey	Form and Instruction	New	Available
Form 1 National Adoption Month	Form and Instruction	New	Available
Form 2 instrument 2	Form and Instruction	New	Available
Form 1 instrument 1	Form and Instruction	New	Available
Form 1 Survey	Form and Instruction	New	Available
Form 1 Workshop Evaluation	Form and Instruction	New	Available
Form 1 Conference Evaluation	Form and Instruction	New	Available
Form 1 Training and Technical Assistance	Form and Instruction	New	Available
Form 1 Survey	Form and Instruction	New	Available
Form 1 Survey	Form and Instruction	New	Available
Form 1 Survey	Form and Instruction	New	Available
Form 1 2013 National Adoption Month Survey	Form and Instruction	New	Available
Form 1 Survey	Form and Instruction	New	Available
Form 1 ANA Services Feedback Survey	Form and Instruction	New	Available
Form 1 2013 National Child Abuse Prevention Month Survey	Form and Instruction	New	Available
Form 1 NFCM	Form and Instruction	New	Available
Form 1 Fatherhood Screener	Form and Instruction	New	Available
ACF Nonmaterial Nonsubstantive Change Request.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2012-11-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214972	Project LAUNCH Multi-Site Evaluation Technical Assistance Grantee Satisfaction Form	Other-Satisfaction Survey	New
214915	Center for States General Assessment for Tailored Services	Form and Instruction	New	Assessment Protocol
214885	ANA Grantee Meeting	Form and Instruction	New	2015 Grantee Meeting Survey
214862	Father Invovlement Communication Checks	Form and Instruction	New	Fatherhood Discussion Guide
214862	Father Invovlement Communication Checks	Form and Instruction	New	Father Screener
214778	Capacity Building Focus Groups	Form and Instruction	New	Service Improvement Interview Protocol
214482	CWIG Customer Satisfaction at Conferences	Form and Instruction	New	Satisfaction Assessment
213876	Infant Toddler Associate Degree Course Survey	Form and Instruction	New	Revised UCinn survey
213604	2015 National Child Abuse Prevention Month Customer Satisfaction Assessment	Form and Instruction	New	Customer Satisfaction Sruvey
213140	Child Welfare Information Gateway 9-14	Form and Instruction	New	General Customer Survey
212742	Naational Adoption Month	Form and Instruction	New	National Adoption Month
212578	OCS Survey	Form and Instruction	New	instrument 2
212578	OCS Survey	Form and Instruction	New	instrument 1
212359	Survey Toolkit	Form and Instruction	New	Survey
211803	ANA Grantee Conference	Form and Instruction	New	Workshop Evaluation
211803	ANA Grantee Conference	Form and Instruction	New	Conference Evaluation
211129	OHS T/TA Survey	Form and Instruction	New	Training and Technical Assistance
210289	Utah Work Success Financial Education	Form and Instruction	New	Survey
209554	Native American Grants Conference	Form and Instruction	New	Survey
208654	Customer Satisfaction Survey for CWIG - Revision	Form and Instruction	New	Survey
208083	2013 National Adoption Month Survey	Form and Instruction	New	2013 National Adoption Month Survey
206943	Child Welfare Information Gateway's Customer Satisfaction Assessment	Form and Instruction	New	Survey
206311	ANA Services Feedback Survey	Form and Instruction	New	ANA Services Feedback Survey
206097	2013 National Child Abuse Prevention Month Special Initiative Survey	Form and Instruction	New	2013 National Child Abuse Prevention Month Survey
205704	NFCM Forms	Form and Instruction	New	NFCM
205449	NRFC	Form and Instruction	New	Fatherhood Screener

ICR Details

OMB Control No: 0970-0401	ICR Reference No: 201211-0970-002
Status: Historical Active	Previous ICR Reference No: 201207-0970-001
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/11/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/19/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2015	04/30/2015	04/30/2015
Responses	32,090	0	7,090
Time Burden (Hours)	7,062	0	4,062
Cost Burden (Dollars)	0	0	0

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Abstract: This is a generic request to seek feedback from the public on service delivery. This is in accordance with the Administrations's commitment to improving service delivery.

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Authorizing Statute(s): PL: Pub.L. 110 - 134 125 Name of Law: Head Start Act of 2007
  

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

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 23

table that charts list of burden

IC Title	Form No.	Form Name
2013 National Adoption Month Survey	1	2013 National Adoption Month Survey
2013 National Child Abuse Prevention Month Special Initiative Survey	1	2013 National Child Abuse Prevention Month Survey
2015 National Child Abuse Prevention Month Customer Satisfaction Assessment	1	Customer Satisfaction Sruvey
ANA Grantee Conference	1, 1	Conference Evaluation ,   Workshop Evaluation
ANA Grantee Meeting	1	2015 Grantee Meeting Survey
ANA Services Feedback Survey	1	ANA Services Feedback Survey
CWIG Customer Satisfaction at Conferences	1	Satisfaction Assessment
Capacity Building Focus Groups	1	Service Improvement Interview Protocol
Center for States General Assessment for Tailored Services	1	Assessment Protocol
Child Welfare Information Gateway 9-14	1	General Customer Survey
Child Welfare Information Gateway's Customer Satisfaction Assessment	1	Survey
Customer Satisfaction Survey for CWIG - Revision	1	Survey
Father Invovlement Communication Checks	1, 1	Father Screener ,   Fatherhood Discussion Guide
Infant Toddler Associate Degree Course Survey	1	Revised UCinn survey
NFCM Forms	1	NFCM
NRFC	1	Fatherhood Screener
Naational Adoption Month	1	National Adoption Month
Native American Grants Conference	1	Survey
OCS Survey	1, 2	instrument 1 ,   instrument 2
OHS T/TA Survey	1	Training and Technical Assistance
Project LAUNCH Multi-Site Evaluation Technical Assistance Grantee Satisfaction Form
Survey Toolkit	1	Survey
Utah Work Success Financial Education	1	Survey

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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	32,090	7,090	0	0	25,000	0
Annual Time Burden (Hours)	7,062	4,062	0	0	3,000	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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

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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: 11/19/2012

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