Information Collection

Potential PFL-eligible low-income mothers

IC 219524 under ICR 201403-0990-004 · OMB 0990-0421.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0421 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0421 revisedFocus Groups guide Attach B_Final.docx	Other-focus groups
0990-0421 revisedPhone_Screen_Attach A_Final.docx	Other-survey
0990-0421 revisedPFL DemoQuestion Attach C_Final.docx	Other-questions
0990-0421 revisedSupportingStatementB_PFL_Final.docx SS part B: Exploring the Relationship between the CA Paid Family Leave Program and the Well-Being of Low-Income Families	IC Document
0990-0421 revised2SupportingStatementA_PFL_Final.docx Support St. A: Exploring the Relationship between the CA Paid Family Leave Program and the Well-Being of Low-Income Families	IC Document
0990-0421 revised2ASPE Generic - Short Supporting Statement cover sheet_PFL Project _FINAL.docx Mini SS: Exploring the Relationship between the CA Paid Family Leave Program and the Well-Being of Low-Income Families	IC Document

IC Title:

Potential PFL-eligible low-income mothers

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-survey	0990-0421 revisedPhone_Screen_Attach A_Final.docx	No	Printable Only
Other-focus groups	0990-0421 revisedFocus Groups guide Attach B_Final.docx	No	Paper Only
Other-questions	0990-0421 revisedPFL DemoQuestion Attach C_Final.docx	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	73	73
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SS part B: Exploring the Relationship between the CA Paid Family Leave Program and the Well-Being of Low-Income Families	0990-0421 revisedSupportingStatementB_PFL_Final.docx	01/13/2016
Support St. A: Exploring the Relationship between the CA Paid Family Leave Program and the Well-Being of Low-Income Families	0990-0421 revised2SupportingStatementA_PFL_Final.docx	01/13/2016
Mini SS: Exploring the Relationship between the CA Paid Family Leave Program and the Well-Being of Low-Income Families	0990-0421 revised2ASPE Generic - Short Supporting Statement cover sheet_PFL Project _FINAL.docx	01/13/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.