Planning Grants to Develop a Model Intervention for Youth/Young Adults with Child Welfare Involvement At-Risk of Homelessness

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
YARH Supporting Statement B revised 3 28 14.docx	Supporting Statement B	Uploaded 2014-03-28	Available
Attachment 3_YARH Supporting Documents.docx	Supplementary Document	Uploaded 2014-01-14	Available
YARH Supporting Statement A revised 3 28 14.docx	Supporting Statement A	Uploaded 2014-03-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210995	Discussion Guide: Focus Groups	Other-Discussion Guide	New
210994	Discussion Guide: Individual Interviews	Other-Discussion Guide	New
210993	Communications for Site Visit Planning	Instruction	New
210089	Survey of Organizational Readiness and Partnership	Other-Survey	New
210088	Survey Sampling Form	Other-Sampling Form	New

ICR Details

OMB Control No: 0970-0445	ICR Reference No: 201401-0970-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No: 21317
Title: Planning Grants to Develop a Model Intervention for Youth/Young Adults with Child Welfare Involvement At-Risk of Homelessness
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: 04/01/2014
	Date Received in OIRA: 01/17/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2016	24 Months From Approved
Responses	450	0	0
Time Burden (Hours)	514	0	0
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 data collection activities with grantee and partner organizations that are receiving planning grant funds through the Children's Bureau (CB) in ACF. These activities will include (1) a survey sampling form to gather contact information for survey respondents and (2) a survey instrument to be used for the process study of efforts by grantees to develop model intervention programs during a two-year period.

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Authorizing Statute(s): PL: Pub.L. 106 - 169 477 Name of Law: Foster Care Independence Act (FCIA) of 1999 amending Title IV-E of the Social Security 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 58309	09/23/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 3209	01/17/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Discussion Guide: Individual Interviews
Discussion Guide: Focus Groups
Communications for Site Visit Planning
Survey Sampling Form
Survey of Organizational Readiness and Partnership

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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	450	0	0	450	0	0
Annual Time Burden (Hours)	514	0	0	514	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: $59,999

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: 01/17/2014

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