Information Collection

Pre-testing of Evaluation Surveys: An Examination of the Intersection of Domestic Human Trafficking with Child Welfare and Runaway and Homeless Youth Programs

IC 218829 under ICR 201501-0970-002 · OMB 0970-0355.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0355 can be found here:

2026-01-30 - No material or nonsubstantive change to a currently approved collection
2025-03-28 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix B. Cognitive Screener v3_Final Draft 102915.pdf	Other-Screener
Appendix A. Survey Instrument Example Screenshots v3_Final Draft 102915.pdf	Other-Survey
Part A_v9_Final Draft 102915.docx Supporting Statement A: Pre-Testing Survey - Intersection of Domestic Human Trafficking with Child Welfare and Runaway and Homel	IC Document
Part B_v9_Final Draft 102915.docx Supporting Statement B: Pre-Testing Survey - Intersection of Domestic Human Trafficking with Child Welfare and Runaway and Homel	IC Document
Appendix C. Sources of Trafficking Questions v2 Final Draft 102915.pdf Appendix C. Sources of Trafficking Questions	IC Document
Appendix D. Consent Forms v3_Final Draft 102915.pdf Appendix D. Consent Forms	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Pre-testing of Evaluation Surveys: An Examination of the Intersection of Domestic Human Trafficking with Child Welfare and Runaway and Homeless Youth Programs

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener			Appendix B. Cognitive Screener v3_Final Draft 102915.pdf		Yes	Yes	Fillable Fileable
Other-Survey			Appendix A. Survey Instrument Example Screenshots v3_Final Draft 102915.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

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	600	600
Annual IC Time Burden (Hours)	168	168
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A: Pre-Testing Survey - Intersection of Domestic Human Trafficking with Child Welfare and Runaway and Homeless Youth Programs	Part A_v9_Final Draft 102915.docx	11/02/2015
Supporting Statement B: Pre-Testing Survey - Intersection of Domestic Human Trafficking with Child Welfare and Runaway and Homeless Youth Programs	Part B_v9_Final Draft 102915.docx	11/02/2015
Appendix C. Sources of Trafficking Questions	Appendix C. Sources of Trafficking Questions v2 Final Draft 102915.pdf	11/02/2015
Appendix D. Consent Forms	Appendix D. Consent Forms v3_Final Draft 102915.pdf	11/02/2015

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