Survey of Supervised Visitation and Safe Exchange Program Grantees and Partners

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1122-XXXX Survey of Supervised Visitation and Safe Exchange Program Grantees and Partners	Form	New	Available
safehavensstatute.pdf	Supplementary Document	Uploaded 2013-09-04	Repair queued
ombrocisSafeHavensSURVEYsupportstatement (Repaired).doc	Supporting Statement A	Uploaded 2013-09-04	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208466	Survey of Supervised Visitation and Safe Exchange Program Grantees and Partners	Form	New

ICR Details

OMB Control No:	ICR Reference No: 201309-1122-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: DOJ/OVW	Agency Tracking No:
Title: Survey of Supervised Visitation and Safe Exchange Program Grantees and Partners
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted	Conclusion Date: 10/01/2013
	Date Received in OIRA: 09/17/2013
Terms of Clearance: This ICR is returned as improperly submitted because it is statistical in nature and requires the submission of a supporting statement part B. In addition, this collection was submitted as a RCF. Before resubmitting this collection, DOJ should check to make sure an request for common form is appropriate for this collection.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection is necessary for the Office on Violence Against Women to collect information about the Safe Havens: Supervised Visitation and Safe Exchange Grant Program current and former grantees and their partners The respondents are current and former grantees and include units of local government, state governments and tribal governments as well nonprofit, nongovernmental victim service providers.

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Authorizing Statute(s): US Code: 42 USC 10420 Name of Law: Violence Against Women 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 39325	05/21/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 43917	07/22/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Survey of Supervised Visitation and Safe Exchange Program Grantees and Partners	1122-XXXX	Safe Haven 10 year Grantee Survey

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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: In an effort to document "the lessons The survey will include 10 questions that will address demographics of families served, type of grant, significant outcomes for their community, and successes and challenges experienced either under the grant program or in general. Most of the questions will be multiple choice or involve a rating scale while a few will include narrative responses.

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Annual Cost to Federal Government: $44,800

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:  Yes

Description/Changes for Common Form Usage: 

Approved RCFs using this ICR

table that charts list of RCF

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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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: 09/17/2013

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