Parents and Children Together (PACT) Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
PACT HM Baseline+Impl+Qual+Hisp Impl - Supp Stat B - 7-15-13.docx	Supporting Statement B	Uploaded 2013-07-23	Available
PACT Appendix K - Invitations and Reminders - 6-17-13.docx	Supplementary Document	Uploaded 2013-07-23	Available
PACT Appendix J - Calculations for Burden Requested - 7-15-13.docx	Supplementary Document	Uploaded 2013-07-23	Available
PACT Appendix I - Consent for Hispanic RF Sub-study Participants - 2-19-13 (1).docx	Supplementary Document	Uploaded 2013-07-23	Available
PACT Appendix H - Consent for HM Program Participants - 6-17-13.docx	Supplementary Document	Uploaded 2013-07-23	Available
PACT Appendix G - Consent Statement for RF Program Participants - 10-31-12 (1).docx	Supplementary Document	Uploaded 2013-07-23	Available
PACT Appendix F - Certificate of Confidentiality- 1-3-13.pdf	Supplementary Document	Uploaded 2013-07-23	Available
PACT Appendix D - HM Baseline Q-by-Q Justification - 2-4-13.docx	Supplementary Document	Uploaded 2013-07-23	Available
PACT Appendix C - RF Baseline Q-by-Q Justification - 10-31-12 (2).docx	Supplementary Document	Uploaded 2013-07-23	Available
PACT Appendix B - Desc Grantee Selection Progress - 1-28-13 (1).docx	Supplementary Document	Uploaded 2013-07-23	Available
PACT Appendix A - Description Eval Strategies.docx	Supplementary Document	Uploaded 2013-07-23	Available
OPRE PACT OMB Non-substantive Change Request - 7-18.13.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2013-07-23	Available
PACT HM Baseline+Impl+Qual+Hisp Impl - SSA-8.13.docx	Supporting Statement A	Uploaded 2013-08-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206014	Instrument #18: Questionnaires for Participants in Focus Group with Hispanic Population Focus	Other-Questionnaire	Modified
206013	Instrument #17: Focus Group Guide - Hispanic Population Focused	Other-Focus Group Guide	Modified
206012	Instrument #16: Semi-structured interview topic guide - Hispanic Population Focus	Other-Topic Guide	Modified
206011	Instrument #15: Check in Call Guide	Other-Guide	Modified
206010	Instrument #14: Guide for in-person, in-depth interviews with study participants	Other-Interview Guide	Modified
206009	Instrument #13: Telephone interviews - Program participants (program dropouts)	Other-Interview	Modified
206008	Instrument #12: Focus Group Guide	Other-Guide	Modified
206007	Instrument 11b: On-line Working Alliance Inventory - Participants	Other-Inventory	Modified
206006	Instrument 11a: On-line Working Alliance Inventory - Program Staff	Other-Inventory	Modified
206005	Instrument #10: Telephone interviews (with staff at referral organizations)	Other-Interview	Modified
206004	Instrument #9: On-line Survey for Program Staff	Other-Survey	Modified
206003	Instrument #8: Semi-structured interview topic guide	Other-Topic Guide	Modified
206002	Instrument #7: HM Study MIS	Other-MIS	Modified
206001	Instrument 5: Baseline survey - HM Study Participants	Other-Survey	Modified
206000	Instrument 4b: Introductory script - HM Program Applicants	Other-Script	Modified
205999	Instrument 4a: Introductory script - Program Staff Burden	Other-Script	Modified
202913	Instrument #6 - RF Study MIS	Other-MIS	Modified
202912	Instrument #3 - Baseline Survey	Other-Survey	Modified
202911	Instrument #2b: Introductory Script - Program Applicants	Other-Script	Modified
202910	Instrument #2a: Introductory Script - Grantee Staff	Other-Script	Modified
200944	Instrument #1: PACT - Discussion Guide	Other-Discussion Guide	Modified

ICR Details

OMB Control No: 0970-0403	ICR Reference No: 201307-0970-009
Status: Historical Active	Previous ICR Reference No: 201303-0970-001
Agency/Subagency: HHS/ACF	Agency Tracking No: 20120
Title: Parents and Children Together (PACT) Evaluation
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: 08/27/2013
	Date Received in OIRA: 07/23/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2016	07/31/2016	07/31/2016
Responses	198,667	0	198,667
Time Burden (Hours)	13,116	0	13,116
Cost Burden (Dollars)	0	0	0

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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 includes: continued use of four existing approved instruments (currently approved under this control number - 0970-0403); clearance for eleven new data collection instruments, for use in the impact evaluations (which includes implementation/qualitative strategies); and clearance for three new instruments for use in implementation/qualitative only evaluation.

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

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? Yes

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Number of Information Collection (IC) in this ICR: 21

table that charts list of burden

IC Title	Form No.	Form Name
Instrument #1: PACT - Discussion Guide
Instrument #2a: Introductory Script - Grantee Staff
Instrument #2b: Introductory Script - Program Applicants
Instrument #3 - Baseline Survey
Instrument #6 - RF Study MIS
Instrument 4a: Introductory script - Program Staff Burden
Instrument 4b: Introductory script - HM Program Applicants
Instrument 5: Baseline survey - HM Study Participants
Instrument #7: HM Study MIS
Instrument #8: Semi-structured interview topic guide
Instrument #9: On-line Survey for Program Staff
Instrument #10: Telephone interviews (with staff at referral organizations)
Instrument 11a: On-line Working Alliance Inventory - Program Staff
Instrument 11b: On-line Working Alliance Inventory - Participants
Instrument #12: Focus Group Guide
Instrument #13: Telephone interviews - Program participants (program dropouts)
Instrument #14: Guide for in-person, in-depth interviews with study participants
Instrument #15: Check in Call Guide
Instrument #16: Semi-structured interview topic guide - Hispanic Population Focus
Instrument #17: Focus Group Guide - Hispanic Population Focused
Instrument #18: Questionnaires for Participants in Focus Group with Hispanic Population Focus

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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	198,667	198,667	0	0	0	0
Annual Time Burden (Hours)	13,116	13,116	0	0	0	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: $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

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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: 07/23/2013

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