Understanding the Dynamics of Disconnection from Employment and Assistance

Forms and Documents

Document Name	Status
Dynamics of Disconnection OMB Package Part B REVISED.doc Supporting Statement B	2013-04-23
Appendix G - Certificate of Approval from Institutional Review Board (IRB) of the Urban Institute.pdf Supplementary Document	2012-12-11
Appendix F - The Urban Institute Staff Confidentiality Pledge.docx Supplementary Document	2012-12-11
Appendix C - Review of Evidence on Disconnection.docx Supplementary Document	2012-12-11
Appendix E - Understanding Disconnection From Employment and Assistance Expert Roundtable Participants.docx Supplementary Document	2012-12-11
Appendix B-2 - Recruitment Letter - Michigan Site REV.docx Supplementary Document	2013-04-23
Appendix B-1S - Advertisement Flyer (Spanish) - Los Angeles Site.docx Supplementary Document	2012-12-11
Appendix B-1 - Advertisement Flyer - Los Angeles Site REV.docx Supplementary Document	2013-04-23
Appendix A-9S - Conversation Guide (Spanish).docx Supplementary Document	2012-12-11
Appendix A-6S - Consent Form for Linking Data (Spanish) - Los Angeles Site.docx Supplementary Document	2012-12-11
Appendix A-5S - Receipt of Payment Form (Spanish) - Los Angeles Site.docx Supplementary Document	2012-12-11
Appendix A-4S - Consent Form For Interviews (Spanish) - Los Angeles Site.docx Supplementary Document	2012-12-11
Appendix A-3S - Follow-up Telephone Script to Schedule Interviews (Spanish) - Los Angeles Site.docx Supplementary Document	2012-12-11
Appendix A-2S - Telephone Recruitment Script and Screener (Spanish) - Los Angeles Site.docx Supplementary Document	2012-12-11
Appendix A-1S - Advertisement Script (Spanish) - Los Angeles Site.docx Supplementary Document	2012-12-11
Dynamics of Disconnection OMB Package Part A REVISED updated 4-18-13.doc Supporting Statement A	2013-04-23

IC Document Collections

IC ID	Document Title	Status
205139	Conversation Guide Other-Discussion Guide	New
205138	Consent Form for Interviews - Michigan Site Other-Consent	New
205137	Appendix A-7 - Telephone Recruitment Script and Screener - Michigan Site Other-Recruitment/Screener	New
205136	Consent Form for Linking Data - Los Angeles Site Other-Consent	New
205135	Receipt of Payment Form - Los Angeles Site Other-Receipt Payment	New
205134	Consent Form For Interviews - Los Angeles Site Other-Consent	New
205133	Follow-up Telephone Script to Schedule Interviews Other-Recruitment	New
205132	Telephone Recruitment Script and Screener - Los Angeles Site Other-Screening Material	New
205131	Advertisement Script - Los Angeles Site Other-Recruitment Materials	New

ICR Details

OMB Control No: 0970-0434	ICR Reference No: 201212-0970-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Understanding the Dynamics of Disconnection from Employment and Assistance
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: 04/23/2013
	Date Received in OIRA: 12/17/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2014	12 Months From Approved
Responses	675	0	0
Time Burden (Hours)	182	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Office of Planning, Research and Evaluation (OPRE) desires to enhance its knowledge about the characteristics, circumstances and well-being of this disconnected population and to develop hypotheses for potential future research. In-depth discussions with disconnected mothers will contribute to improved understanding of specific reasons for their unemployment and lack of assistance, families' coping strategies, and families' perspectives on pathways out of disconnection.

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Authorizing Statute(s): US Code: 42 USC 613 Name of Law: Social Security Act: Research, Evaluations, and National Studies
  

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:
	77 FR 10533	02/22/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 74666	12/17/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 9

IC Title	Form No.	Form Name
Consent Form For Interviews - Los Angeles Site
Receipt of Payment Form - Los Angeles Site
Advertisement Script - Los Angeles Site
Telephone Recruitment Script and Screener - Los Angeles Site
Follow-up Telephone Script to Schedule Interviews
Consent Form for Linking Data - Los Angeles Site
Appendix A-7 - Telephone Recruitment Script and Screener - Michigan Site
Consent Form for Interviews - Michigan Site
Conversation Guide

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ICR Summary 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	675	0	0	675	0	0
Annual Time Burden (Hours)	182	0	0	182	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: $145,526

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

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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: 12/17/2012

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