Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Conference Satisfaction Survey	Form and Instruction	New	Available
Form 1 TA State Systems Network Feedback	Form and Instruction	New	Available
Form 1 Meeting Facilitation	Form and Instruction	New	Available
Form 1 Administrator Feedback Collection	Form and Instruction	New	Available
Form 1 SCBC Task 3	Form and Instruction	New	Available
Form 1 Follow-up Needsw Assessment Feedback Form	Form and Instruction	New	Available
Form 1 Institute Feedback Form	Form and Instruction	New	Available
Form 1 SCBC Task 2	Form and Instruction	New	Available
Form 1 IC for 2017 ACF Grantee Meeting	Form and Instruction	New	Available
Form 1 DCP Stakeholder Interview Guide	Form and Instruction	New	Available
Form 1 OTIP DCP Survey Questionnaire	Form and Instruction	New	Available
Form 1 3 Year Posst Project Survey	Form and Instruction	New	Available
Form 1 AFI Instruction and Instruments.	Form and Instruction	New	Available
Form 1 ECLKC Tree Testing Script	Form and Instruction	New	Available
Form 1 ANA TTA Survey Questions	Form and Instruction	New	Available
Form 1 ANA Comms Survey Questions Survey Monkey	Form and Instruction	New	Available
Form 1 NDMI Live Learning Event Survey	Form and Instruction	New	Available
Form 1 Fast Track Toolkit Survey Instrument	Form and Instruction	New	Available
Form 1 Grantee Workshop Survey Instrument	Form and Instruction	New	Available
Form 1 PMFO Fiscal Consulting Survey	Form and Instruction	New	Available
Form 1 CapLearn registration fields	Form and Instruction	New	Available
Form 1 VirtualConference FocusGroupGuide	Form and Instruction	New	Available
Form 1 Fiscal Consulting Survey	Form and Instruction	New	Available
Form 1 Event Session Survey	Form and Instruction	New	Available
Form 1 PMFO Conference Survey	Form and Instruction	New	Available
Form 1 SOAR End-of-Course Evaluation	Form and Instruction	New	Available
Form 1 Generic Request	Form and Instruction	New	Available
Form 1 Exit Survey	Form and Instruction	New	Available
Form 1 Justification	Form and Instruction	New	Available
Form 1 OTIP Fast Track Request	Form and Instruction	New	Repair queued
Form 1 NFCAD Survey	Form and Instruction	New	Available
Form 1 Center for States Needs Assessment Survey 2016	Form and Instruction	New	Available
Form 1 AFI Outreach Instruments	Form and Instruction	New	Available
Form 1 Fatherhood Screener Comm Check	Form and Instruction	New	Available
Form 1 CWIG Special Inititiative Survey for OMB 1-20-16	Form and Instruction	New	Available
Form 1 VT BICS Draft Questionaire 2-8-16	Form and Instruction	New	Repair queued
Form 1 Media Consumption Survey Instrument	Form and Instruction	New	Available
Form 1 Fast Track Instrument	Form and Instruction	New	Available
Form 1 CED Grantee Needs Assessmenr	Form and Instruction	New	Available
Form 1 Special Initiative Survey	Form and Instruction	New	Available
Form 1 Capacity Building Collaborative Customer Feedback Instrument	Form and Instruction	New	Available
Form 1 AFI Outreach Assessment	Form and Instruction	New	Available
Form 1 Capacity Building Collaborative Customer Feedback Instrument	Form and Instruction	New	Available
Form 1 Center for States Intensive Capacity Building Project	Form and Instruction	New	Available
Form 1 AFI Capacity Building Visit Feedback Form	Form and Instruction	New	Available
Form 1 National Responsible Fatherhood Clearinghouse (NRFC)	Form and Instruction	New	Available
Form 1 FEI Website Survey	Form and Instruction	New	Available
Form 1 Focus Group	Form and Instruction	New	Available
Supporting Statement for Fast Track 1-15.docx	Supporting Statement A	Uploaded 2015-02-04	Available
ACF Nonmaterial Nonsubstantive Change Request.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2012-11-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227063	Early Head Start Conference Satisfaction Survey	Form and Instruction	New	Conference Satisfaction Survey
227009	MIECHV CQI Practicum, Mid-Practicum Feedback Questions	Other-Survey	New
226904	OAS-TA State Systems Specialist Network Feedback	Form and Instruction	New	TA State Systems Network Feedback
226903	OAS-On-Site Meeting Facilitation State Feedback Collection	Form and Instruction	New	Meeting Facilitation
226902	OAS-Administrator Feedback Collection	Form and Instruction	New	Administrator Feedback Collection
226898	OAS-TA Feedback Collection for Infant Toddler	Form and Instruction	New	SCBC Task 3
226784	Follow-Up Needs Assessment Feedback Form	Form and Instruction	New	Follow-up Needsw Assessment Feedback Form
226782	Institute Feedback Form	Form and Instruction	New	Institute Feedback Form
226773	OAS-Specialized Resources TA Feedback Collection	Form and Instruction	New	SCBC Task 2
226527	Soliciatation of Opinions for 2017 ACF Native American Grantee Meeting	Form and Instruction	New	IC for 2017 ACF Grantee Meeting
226463	Human Trafficking Data Collection Pilot	Form and Instruction	New	DCP Stakeholder Interview Guide
226463	Human Trafficking Data Collection Pilot	Form and Instruction	New	OTIP DCP Survey Questionnaire
226361	ANA Sustainablility Servicers Survey	Form and Instruction	New	3 Year Posst Project Survey
225778	Participant Feedback Form for the CCDBG Implementation Research and Evaluation Planning Grantee Community of Practice Meeting	Other-Feedback From	New
225714	Feedback on Mother and Infant Home Visiting Program Evaluation (MIHOPE) Long-term Follow-up study design options	Other-Discussion Questions	New
225618	Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2017 Annual Meeting	Other-Survey	New
225050	ACF Office of Regional Operations Customer Feedback for Learning Experiences	Other-Survey	New
224993	OCS-AFI Application Readiness Assessment Questions for Cohert Participants	Form and Instruction	New	AFI Instruction and Instruments.
224990	HS-ECLKC Tree Testing	Form and Instruction	New	ECLKC Tree Testing Script
224679	ANA Training and Technical Assistance Services Survey	Form and Instruction	New	ANA TTA Survey Questions
224610	MIECHV Grantee Feedback on Data and Evaluation Technical Assistance	Other-Small group discussion	New
224345	ANA 2016 Communication Survey	Form and Instruction	New	ANA Comms Survey Questions Survey Monkey
223858	PMFO New Director Mentor Iniative	Form and Instruction	New	NDMI Live Learning Event Survey
223811	Input on Agenda for 2017 Annual Meeting of Child Care and Early Education Policy Research Consortium	Other-Survey	New
223686	AFI Capacity Building Toolkit Usability Test	Form and Instruction	New	Fast Track Toolkit Survey Instrument
223591	AFI Grantee Workshop Evaluation Survey	Form and Instruction	New	Grantee Workshop Survey Instrument
223533	PMFO Fiscal Consulting Inititative Feedback Survey	Form and Instruction	New	PMFO Fiscal Consulting Survey
223306	CWCB CapLEARN	Form and Instruction	New	CapLearn registration fields
223215	Child Welfare Capacity Building Collaborative Focus Group	Form and Instruction	New	VirtualConference FocusGroupGuide
223172	OHS-Fiscal Consulting Survey	Form and Instruction	New	Fiscal Consulting Survey
223170	OHS-Event Session Survey	Form and Instruction	New	Event Session Survey
223166	OHS-Conference Feedback Survey	Form and Instruction	New	PMFO Conference Survey
223017	SOAR Human Trafficking Training End-of-Course Evaluation	Form and Instruction	New	SOAR End-of-Course Evaluation
222295	Virtual Conference Session Evaluation	Form and Instruction	New	Generic Request
222294	CWIG Virtual Conference Exit Survey	Form and Instruction	New	Exit Survey
221800	SOAR End of Course Evaluation	Form and Instruction	New	Justification
221738	OTIP	Form and Instruction	New	OTIP Fast Track Request
221682	Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinars 3&4	Other-	New
221461	National Foster Care and Adoption Directory Survey	Form and Instruction	New	NFCAD Survey
221111	Center for States - 2015	Form and Instruction	New	Center for States Needs Assessment Survey 2016
220980	Investigation and Analysis of AFI	Form and Instruction	New	AFI Outreach Instruments
220065	Father Involvement Communication Checks	Form and Instruction	New	Fatherhood Screener Comm Check
220048	Child Welfare Information Gateways's Special Inititative Survey	Form and Instruction	New	CWIG Special Inititiative Survey for OMB 1-20-16
220018	BICS Vermont Grant Resolution Meeting Customer Satisfaction	Form and Instruction	New	VT BICS Draft Questionaire 2-8-16
220013	Center for States Media Consumption Survey	Form and Instruction	New	Media Consumption Survey Instrument
219984	Tribal MIECHV Data System Planning	Other-Survey	New
219933	Constituency Group Survey	Form and Instruction	New	Fast Track Instrument
219265	OCS CED Focus Group	Form and Instruction	New	CED Grantee Needs Assessmenr
219240	Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinar	Other-survey and polls	New
219077	Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting	Other-Feedback form	New
218714	Special Initiative Survey	Form and Instruction	New	Special Initiative Survey
218540	Capacity Building Collaborative Customer Feedback for Learning Experiences	Form and Instruction	New	Capacity Building Collaborative Customer Feedback Instrument
218317	AFI Outreach Survey	Form and Instruction	New	AFI Outreach Assessment
218119	Collaborative Customer Feedback	Form and Instruction	New	Capacity Building Collaborative Customer Feedback Instrument
218106	Comment Form: 2015 OPRE Innovative Methods Meeting	Other-Comment form	New
217606	Center for States	Form and Instruction	New	Center for States Intensive Capacity Building Project
217090	Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting	Other-Survey	New
216671	AFI Capacity Building Visit	Form and Instruction	New	AFI Capacity Building Visit Feedback Form
216659	Center for Urban Families (CFUF)	Form and Instruction	New	National Responsible Fatherhood Clearinghouse (NRFC)
216644	FEI Website Survey	Form and Instruction	New	FEI Website Survey
216642	FEI Focus Group	Form and Instruction	New	Focus Group

ICR Details

OMB Control No: 0970-0401	ICR Reference No: 201502-0970-004
Status: Historical Active	Previous ICR Reference No: 201211-0970-002
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/12/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/24/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved	05/31/2015
Responses	14,124	0	32,090
Time Burden (Hours)	7,062	0	7,062
Cost Burden (Dollars)	0	0	0

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Abstract: This is a generic request to seek feedback from the public on service delivery. This is in accordance with the Administrations's commitment to improving service delivery.

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Authorizing Statute(s): PL: Pub.L. 110 - 134 125 Name of Law: Head Start Act of 2007
  

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:
	79 FR 69492	11/21/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 3606	01/23/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 60

table that charts list of burden

IC Title	Form No.	Form Name
ACF Office of Regional Operations Customer Feedback for Learning Experiences
AFI Capacity Building Toolkit Usability Test	1	Fast Track Toolkit Survey Instrument
AFI Capacity Building Visit	1	AFI Capacity Building Visit Feedback Form
AFI Grantee Workshop Evaluation Survey	1	Grantee Workshop Survey Instrument
AFI Outreach Survey	1	AFI Outreach Assessment
ANA 2016 Communication Survey	1	ANA Comms Survey Questions Survey Monkey
ANA Sustainablility Servicers Survey	1	3 Year Posst Project Survey
ANA Training and Technical Assistance Services Survey	1	ANA TTA Survey Questions
BICS Vermont Grant Resolution Meeting Customer Satisfaction	1	VT BICS Draft Questionaire 2-8-16
CWCB CapLEARN	1	CapLearn registration fields
CWIG Virtual Conference Exit Survey	1	Exit Survey
Capacity Building Collaborative Customer Feedback for Learning Experiences	1	Capacity Building Collaborative Customer Feedback Instrument
Center for States	1	Center for States Intensive Capacity Building Project
Center for States - 2015	1	Center for States Needs Assessment Survey 2016
Center for States Media Consumption Survey	1	Media Consumption Survey Instrument
Center for Urban Families (CFUF)	1	National Responsible Fatherhood Clearinghouse (NRFC)
Child Welfare Capacity Building Collaborative Focus Group	1	VirtualConference FocusGroupGuide
Child Welfare Information Gateways's Special Inititative Survey	1	CWIG Special Inititiative Survey for OMB 1-20-16
Collaborative Customer Feedback	1	Capacity Building Collaborative Customer Feedback Instrument
Comment Form: 2015 OPRE Innovative Methods Meeting
Constituency Group Survey	1	Fast Track Instrument
Early Head Start Conference Satisfaction Survey	1	Conference Satisfaction Survey
FEI Focus Group	1	Focus Group
FEI Website Survey	1	FEI Website Survey
Father Involvement Communication Checks	1	Fatherhood Screener Comm Check
Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2017 Annual Meeting
Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinar
Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinars 3&4
Feedback on Mother and Infant Home Visiting Program Evaluation (MIHOPE) Long-term Follow-up study design options
Follow-Up Needs Assessment Feedback Form	1	Follow-up Needsw Assessment Feedback Form
HS-ECLKC Tree Testing	1	ECLKC Tree Testing Script
Human Trafficking Data Collection Pilot	1, 1	OTIP DCP Survey Questionnaire ,   DCP Stakeholder Interview Guide
Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting
Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting
Input on Agenda for 2017 Annual Meeting of Child Care and Early Education Policy Research Consortium
Institute Feedback Form	1	Institute Feedback Form
Investigation and Analysis of AFI	1	AFI Outreach Instruments
MIECHV CQI Practicum, Mid-Practicum Feedback Questions
MIECHV Grantee Feedback on Data and Evaluation Technical Assistance
National Foster Care and Adoption Directory Survey	1	NFCAD Survey
OAS-Administrator Feedback Collection	1	Administrator Feedback Collection
OAS-On-Site Meeting Facilitation State Feedback Collection	1	Meeting Facilitation
OAS-Specialized Resources TA Feedback Collection	1	SCBC Task 2
OAS-TA Feedback Collection for Infant Toddler	1	SCBC Task 3
OAS-TA State Systems Specialist Network Feedback	1	TA State Systems Network Feedback
OCS CED Focus Group	1	CED Grantee Needs Assessmenr
OCS-AFI Application Readiness Assessment Questions for Cohert Participants	1	AFI Instruction and Instruments.
OHS-Conference Feedback Survey	1	PMFO Conference Survey
OHS-Event Session Survey	1	Event Session Survey
OHS-Fiscal Consulting Survey	1	Fiscal Consulting Survey
OTIP	1	OTIP Fast Track Request
PMFO Fiscal Consulting Inititative Feedback Survey	1	PMFO Fiscal Consulting Survey
PMFO New Director Mentor Iniative	1	NDMI Live Learning Event Survey
Participant Feedback Form for the CCDBG Implementation Research and Evaluation Planning Grantee Community of Practice Meeting
SOAR End of Course Evaluation	1	Justification
SOAR Human Trafficking Training End-of-Course Evaluation	1	SOAR End-of-Course Evaluation
Soliciatation of Opinions for 2017 ACF Native American Grantee Meeting	1	IC for 2017 ACF Grantee Meeting
Special Initiative Survey	1	Special Initiative Survey
Tribal MIECHV Data System Planning
Virtual Conference Session Evaluation	1	Generic Request

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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	14,124	32,090	0	0	-17,966	0
Annual Time Burden (Hours)	7,062	7,062	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,000

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:  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: 02/24/2015

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