Project LAUNCH Cross-Site Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Project LAUNCH SSB Template_052013_rev.doc	Supporting Statement B	Uploaded 2013-06-05	Available
Appendix_J_CSE.Interview.Consent_052213.docx	Supplementary Document	Uploaded 2013-06-05	Available
Project_LAUNCH_SSA_Template_052213_9.9.13_clean.docx	Supporting Statement A	Uploaded 2013-09-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207347	Outcomes Data Tables in End of Year Reports	Other-Data Tables	New
207346	Chair of State Child Wellness Council Interview Guide	Other-Interview	New
207345	State Child Wellness Coordinator Interview Guide	Other-Interview	New
207344	Local Stakeholder Interview Guide	Other-Interview	New
207343	Chair of Local Child Wellness Council Interview Guide	Other-Interview	New
207342	Child Wellness Coordinator Interview Guide	Other-Interview	New
191015	Electronic Data Reporting: Services Measures	Other-Electronic Reporting	Modified
191014	Electronic Data Reporting: Systems Measures	Other-Data Reporting	Modified
191013	Site Visit and Telephone Interview Guide	Other-Interview Protocol	Removed

ICR Details

OMB Control No: 0970-0373	ICR Reference No: 201306-0970-002
Status: Historical Active	Previous ICR Reference No: 201105-0970-001
Agency/Subagency: HHS/ACF	Agency Tracking No: 19738
Title: Project LAUNCH Cross-Site 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: 09/09/2013
	Date Received in OIRA: 06/13/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2016	36 Months From Approved	07/31/2014
Responses	264	0	336
Time Burden (Hours)	1,000	0	876
Cost Burden (Dollars)	0	0	0

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Abstract: The Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services (HHS) seeks approval for collection of data from an additional fourth cohort of 11 cooperative agreements funded in September 2012 for the cross-site evaluation of Project LAUNCH (Linking Actions for Unmet Needs in Children's Health). The request to collect data from these 11 cooperative agreements is in addition to OMB-approved data collection at 24 cooperative agreements funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) under Project LAUNCH (OMB Control# 0970-0373): 6 cooperative agreements in September 2008 (Cohort 1), 12 additional cooperative agreements in September 2009 (Cohort 2), and 6 more cooperative agreements in September 2010 (Cohort 3). Data collection for Cohort 4 (funded September 2012) grantees will follow the same schedule as the other Cohorts.

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Authorizing Statute(s): US Code: 42 USC 520A Name of Law: Public Health Service Act
  

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:
	78 FR 12328	02/22/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 34661	06/10/2013
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
Electronic Data Reporting: Systems Measures
Electronic Data Reporting: Services Measures
Child Wellness Coordinator Interview Guide
Chair of Local Child Wellness Council Interview Guide
Local Stakeholder Interview Guide
State Child Wellness Coordinator Interview Guide
Chair of State Child Wellness Council Interview Guide
Outcomes Data Tables in End of Year Reports
Site Visit and Telephone Interview Guide

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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	264	336	0	-72	0	0
Annual Time Burden (Hours)	1,000	876	0	124	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The annual time burden increased for two reasons: 1) the addition of a new instrument, the Outcomes Data Tables in End of Year Reports-there are 216 Annual Burden Hours associated with this new instrument; and 2) a slight increase (from 576 to 648) in the total Annual Burden Hours for the two Electronic Data Reporting instruments because of the increase from 24 to 27 in the annual number of grantees using these two sets of instruments.

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Annual Cost to Federal Government: $407,863

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: 06/13/2013

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