Regional Partnership Grants National Cross-Site Evaluation and Evaluation Technical Assistance

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VIIB Household Ros VIIB Household Roster	Form and Instruction	New	Available
Form VIIB Household Ros VIIB Household Roster	Form and Instruction	New	Available
Form VIB Household Rost VIB Household Roster	Form and Instruction	New	Available
Form VIB Household Rost VIB Household Roster	Form and Instruction	New	Available
Form VA Partner Survey VA Partner Survey	Form and Instruction	New	Available
Form VA Partner Survey VA Partner Survey	Form and Instruction	New	Available
Form IVA Staff Survey IVA Staff Survey	Form	New	Available
Form IVA Staff Survey IVA Staff Survey	Form	New	Available
Form IIE Adherence Form IIE Adherence Form	Form and Instruction	New	Available
Form IID Description of IID Description of Partnerships	Form and Instruction	New	Available
Form IIC Description of IIC Description of Other Services and Activities	Form and Instruction	New	Available
Form IIA Semi-Annual Pr IIA Semi-Annual Progress Report Form	Form and Instruction	New	Available
Form IIB Description of IIB Description of Evidence-Based Practices	Form and Instruction	New	Available
Form IIE Adherence Form IIE Adherence Form	Form and Instruction	New	Available
Form IID Description of IID Description of Partnerships	Form and Instruction	New	Available
Form IIC Description of IIC Description of Other Services and Activities	Form and Instruction	New	Available
Form IIB Description of IIB Description of Evidence-Based Practices	Form and Instruction	New	Available
Form IIA Semi-Annual Pr IIA Semi-Annual Progress Report Form	Form and Instruction	New	Available
Form IB Site Visit Info IB Site Visit Informant Form	Form and Instruction	New	Available
Form IB Site Visit Info IB Site Visit Informant Form	Form and Instruction	New	Available
Form IB Site Visit Info IB Site Visit Informant Form	Form and Instruction	New	Available
Form IB Site Visit Info IB Site Visit Informant Form	Form and Instruction	New	Available
Form IB Site Visit Info IB Site Visit Informant Form	Form and Instruction	New	Available
Form IB Site Visit Info IB Site Visit Informant Form	Form and Instruction	New	Available
Form IA Interview Topic IA Interview Topic Guide	Form and Instruction	New	Available
Form IB Site Visit Info IB Site Visit Informant Form	Form and Instruction	New	Available
Form IA Interview Topic IA Interview Topic Guide	Form and Instruction	New	Available
Part_B.docx	Supporting Statement B	Uploaded 2013-12-20	Available
VIII Copy of legislation.pdf	Supplementary Document	Uploaded 2013-12-20	Available
VIIA Standardized Instruments.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VIIC Administrative Data Elements.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VIIA Standardized Instruments.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VIIC Administrative Data Elements.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VIA Standardized Instruments.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VIC Administrative Data Elements.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VIA Standardized Instruments.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VIC Administrative Data Elements.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VIC Administrative Data Elements.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VIC Administrative Data Elements.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VH Partner Survey Thank-You Email.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VG Partner Survey Grantee Reminder Request.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VF Partner Survey Final Reminder Email.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VE Partner Survey Reminder Email.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VD Partner Survey Email Invitation.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VC Partner Survey Advance Email.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VB Partner Survey FAQ.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VH Partner Survey Thank-You Email.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VG Partner Survey Grantee Reminder Request.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VF Partner Survey Final Reminder Email.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VE Partner Survey Reminder Email.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VD Partner Survey Email Invitation.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VC Partner Survey Advance Email.pdf	Supplementary Document	Uploaded 2013-12-09	Available
VB Partner Survey FAQ.pdf	Supplementary Document	Uploaded 2013-12-09	Available
IVG Staff Survey Grantee Reminder Request.pdf	Supplementary Document	Uploaded 2013-12-09	Available
IVF Staff Survey Final Reminder Email.pdf	Supplementary Document	Uploaded 2013-12-09	Available
IVE Staff Survey Reminder Email.pdf	Supplementary Document	Uploaded 2013-12-09	Available
IVC Staff Survey Advance Email.pdf	Supplementary Document	Uploaded 2013-12-09	Available
IVB Staff Survey FAQ.pdf	Supplementary Document	Uploaded 2013-12-09	Available
IVD Staff Survey Email Invitation.pdf	Supplementary Document	Uploaded 2013-12-09	Available
IVG Staff Survey Grantee Reminder Request.pdf	Supplementary Document	Uploaded 2013-12-09	Available
IVF Staff Survey Final Reminder Email.pdf	Supplementary Document	Uploaded 2013-12-09	Available
IVE Staff Survey Reminder Email.pdf	Supplementary Document	Uploaded 2013-12-09	Available
IVC Staff Survey Advance Email.pdf	Supplementary Document	Uploaded 2013-12-09	Available
IVB Staff Survey FAQ.pdf	Supplementary Document	Uploaded 2013-12-09	Available
IVD Staff Survey Email Invitation.pdf	Supplementary Document	Uploaded 2013-12-09	Available
III Enrollment and Service Log Data Dictionary_rev copy.pdf	Supplementary Document	Uploaded 2013-12-09	Available
III Enrollment and Service Log Data Dictionary_rev copy.pdf	Supplementary Document	Uploaded 2013-12-09	Available
III Enrollment and Service Log Data Dictionary_rev copy.pdf	Supplementary Document	Uploaded 2013-12-09	Available
III Enrollment and Service Log Data Dictionary_rev copy.pdf	Supplementary Document	Uploaded 2013-12-09	Available
IB Site Visit Informant Form.pdf	Supplementary Document	Uploaded 2013-12-06	Available
Part_A revised 12-3-13 clean.docx	Supporting Statement A	Uploaded 2013-12-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209841	Data entry for comparison study sites - Government	Form and Instruction	New	VIIB Household Roster
209840	Data entry for comparison study sites - Private sector	Form and Instruction	New	VIIB Household Roster
209839	Review records and submit data electronically - Government		New
209838	Review records and submit data electronically - Private Sector		New
209837	Enter data into local databases - Government		New
209836	Enter data into local databases - Private Sector		New
209835	Review and adopt reporting templates - Government		New
209834	Review and adopt reporting templates - Private Sector		New
209833	Report Administrative data - Government	Form and Instruction	New	VIB Household Roster
209832	Report administrative data - Private Sector	Form and Instruction	New	VIB Household Roster
209831	Obtain access to administrative data - Government		New
209830	Obtain Access to Administrative Data - Private Sector		New
209829	Partner Survey - Government	Form and Instruction	New	VA Partner Survey
209828	Partner Survey - Private Sector	Form and Instruction	New	VA Partner Survey
209827	Staff Survey - Government	Form	New	IVA Staff Survey
209826	Staff Survey - Private Sector	Form	New	IVA Staff Survey
209825	Service Log Entries - Government		New
209824	Service log entries - Private Sector		New
209823	Case Enrollment Data - Government		New
209822	Case enrollment data - Private Sector		New
209821	Semi-annual progress reports - Government	Form and Instruction	New	IIE Adherence Form
209821	Semi-annual progress reports - Government	Form and Instruction	New	IID Description of Partnerships
209821	Semi-annual progress reports - Government	Form and Instruction	New	IIC Description of Other Services and Activities
209821	Semi-annual progress reports - Government	Form and Instruction	New	IIA Semi-Annual Progress Report Form
209821	Semi-annual progress reports - Government	Form and Instruction	New	IIB Description of Evidence-Based Practices
209820	Semi-annual progress reports - Private Sector	Form and Instruction	New	IIE Adherence Form
209820	Semi-annual progress reports - Private Sector	Form and Instruction	New	IID Description of Partnerships
209820	Semi-annual progress reports - Private Sector	Form and Instruction	New	IIC Description of Other Services and Activities
209820	Semi-annual progress reports - Private Sector	Form and Instruction	New	IIB Description of Evidence-Based Practices
209820	Semi-annual progress reports - Private Sector	Form and Instruction	New	IIA Semi-Annual Progress Report Form
209819	Frontline staff individual interview - Government	Form and Instruction	New	IB Site Visit Informant Form
209819	Frontline staff individual interview - Government	Other-Interview Topic Guide	New
209818	Frontline staff individual interview - Private sector	Form and Instruction	New	IB Site Visit Informant Form
209818	Frontline staff individual interview - Private sector	Other-Interview Topic Guide	New
209817	Program manger/supervisor individual interview - Government	Form and Instruction	New	IB Site Visit Informant Form
209817	Program manger/supervisor individual interview - Government	Other-Interview Topic Guide	New
209816	Program manger/supervisor individual interview - Private Sector	Form and Instruction	New	IB Site Visit Informant Form
209816	Program manger/supervisor individual interview - Private Sector	Other-Interview Topic Guide	New
209815	Program manager/supervisor group interview - Government	Form and Instruction	New	IB Site Visit Informant Form
209815	Program manager/supervisor group interview - Government	Other-Interview Topic Guide	New
209814	Program Manager/Supervisor Group Interview - Private Sector	Form and Instruction	New	IB Site Visit Informant Form
209814	Program Manager/Supervisor Group Interview - Private Sector	Other-Interview Topic Guide	New
209813	Program Director Individual Interview - Government	Form and Instruction	New	IA Interview Topic Guide
209812	Program Director Individual Interview - Private Sector	Form and Instruction	New	IB Site Visit Informant Form
209812	Program Director Individual Interview - Private Sector	Form and Instruction	New	IA Interview Topic Guide

ICR Details

OMB Control No: 0970-0444	ICR Reference No: 201312-0970-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No: 21073
Title: Regional Partnership Grants National Cross-Site Evaluation and Evaluation Technical 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 without change	Conclusion Date: 03/18/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/20/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved
Responses	81,968	0	0
Time Burden (Hours)	18,860	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Children's Bureau seeks approval to collect information for the Regional Partnership Grants to Increase the Well-being of and Improve Permanency Outcomes for Children Affected by Substance Abuse (i.e., Regional Partnership Grants Program or "RPG") Cross-Site Evaluation and Evaluation-Related Technical Assistance project (the "RPG Cross-Site Evaluation"). The overall objective of the RPG Cross-Site Evaluation is to plan, develop, and implement a rigorous national cross-site evaluation of the RPG Grant Program, provide legislatively-mandated performance measurement, and furnish evaluation-related technical assistance to the grantees to improve the quality and rigor of their local evaluations. The project will document the programs and activities conducted through the RPG program and assess the extent to which the grants have been successful in addressing the needs of families with substance abuse problems who come to the attention of the child welfare system.

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Authorizing Statute(s): PL: Pub.L. 112 - 34 437 Name of Law: Child and Family Services Improvement 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 57641	09/19/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 72679	12/03/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 30

table that charts list of burden

IC Title	Form No.	Form Name
Case Enrollment Data - Government
Case enrollment data - Private Sector
Data entry for comparison study sites - Government	VIIB Household Roster	VIIB Household Roster
Data entry for comparison study sites - Private sector	VIIB Household Roster	VIIB Household Roster
Enter data into local databases - Government
Enter data into local databases - Private Sector
Frontline staff individual interview - Government	IB Site Visit Informant Form	IB Site Visit Informant Form
Frontline staff individual interview - Private sector	IB Site Visit Informant Form	IB Site Visit Informant Form
Obtain Access to Administrative Data - Private Sector
Obtain access to administrative data - Government
Partner Survey - Government	VA Partner Survey	VA Partner Survey
Partner Survey - Private Sector	VA Partner Survey	VA Partner Survey
Program Director Individual Interview - Government	IA Interview Topic Guide	IA Interview Topic Guide
Program Director Individual Interview - Private Sector	IA Interview Topic Guide, IB Site Visit Informant Form	IA Interview Topic Guide ,   IB Site Visit Informant Form
Program Manager/Supervisor Group Interview - Private Sector	IB Site Visit Informant Form	IB Site Visit Informant Form
Program manager/supervisor group interview - Government	IB Site Visit Informant Form	IB Site Visit Informant Form
Program manger/supervisor individual interview - Government	IB Site Visit Informant Form	IB Site Visit Informant Form
Program manger/supervisor individual interview - Private Sector	IB Site Visit Informant Form	IB Site Visit Informant Form
Report Administrative data - Government	VIB Household Roster	VIB Household Roster
Report administrative data - Private Sector	VIB Household Roster	VIB Household Roster
Review and adopt reporting templates - Government
Review and adopt reporting templates - Private Sector
Review records and submit data electronically - Government
Review records and submit data electronically - Private Sector
Semi-annual progress reports - Government	IIB Description of Evidence-Based Practices, IIA Semi-Annual Progress Report Form, IIC Description of Other Services and Activities, IID Description of Partnerships, IIE Adherence Form	IIB Description of Evidence-Based Practices ,   IIA Semi-Annual Progress Report Form ,   IIC Description of Other Services and Activities ,   IID Description of Partnerships ,   IIE Adherence Form
Semi-annual progress reports - Private Sector	IIA Semi-Annual Progress Report Form, IIB Description of Evidence-Based Practices, IIC Description of Other Services and Activities, IID Description of Partnerships, IIE Adherence Form	IIA Semi-Annual Progress Report Form ,   IIB Description of Evidence-Based Practices ,   IIC Description of Other Services and Activities ,   IID Description of Partnerships ,   IIE Adherence Form
Service Log Entries - Government
Service log entries - Private Sector
Staff Survey - Government	IVA Staff Survey	IVA Staff Survey
Staff Survey - Private Sector	IVA Staff Survey	IVA Staff 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	81,968	0	0	81,968	0	0
Annual Time Burden (Hours)	18,860	0	0	18,860	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 ICR.

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Annual Cost to Federal Government: $1,157,654

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: 12/20/2013

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