Cross-site Evaluation Survey of 2012 Family Connection Grantees

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Evaluator Protocol	Form and Instruction	New	Available
Form 1 Community Partner Protocol	Form and Instruction	New	Available
Form 1 Public Child Welfare Partner Protocol	Form and Instruction	New	Available
Form 1 Service Provider Protocol	Form and Instruction	New	Available
Form 1 Project Leadership Protocol	Form and Instruction	New	Repair queued
APPENDIX II Surveys.pdf	Supplementary Document	Uploaded 2015-06-18	Available
APPENDIX I Attachments A-J 6-17-15.pdf	Supplementary Document	Uploaded 2015-06-18	Available
Part A-Cross Site Evaluation for 2012 - THE SUPPORTING STATEMENT.docx	Supporting Statement A	Uploaded 2015-06-18	Available
Part B - Cross Site Evaluation for 2012 -THE SUPPORTING STATEMENT.docx	Supporting Statement B	Uploaded 2015-06-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
215176	Evaluator Protocol	Form and Instruction	New
215175	Community Partner Protocol	Form and Instruction	New
215174	Public Child Welfare Partner Protocol	Form and Instruction	New
215173	Service Provider Protocol	Form and Instruction	New
215172	Project Leadership Protocol	Form and Instruction	New

ICR Details

OMB Control No: 0970-0456	ICR Reference No: 201502-0970-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No: CB
Title: Cross-site Evaluation Survey of 2012 Family Connection Grantees
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: 06/22/2015
	Date Received in OIRA: 03/17/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2018	36 Months From Approved
Responses	351	0	0
Time Burden (Hours)	192	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: In the interest of providing as complete an evaluation report as possible by the end of FY15, the Children's Bureau has directed the contractor conducting the Cross-site Evaluation to adopt the most efficient means possible to collect process evaluation data from grantees. The proposed electronic survey will replace originally planned in-person and telephone discussions with electronic surveys. This will enable collection of key information on project design, implementation, maintenance, and sustainability from key grantee representatives in an abbreviated amount of time. The quantitative nature of the surveys will enable rapid data analysis and reporting.

---

Authorizing Statute(s): PL: Pub.L. 113 - 183 221 Name of Law: Sex Trafficking and Strengthening Families Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 67167	11/12/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 6520	02/05/2015
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Public Child Welfare Partner Protocol	1	Appendix II Surveys
Community Partner Protocol	1	Appendix II Surveys
Project Leadership Protocol	1	Appendix II Surveys
Service Provider Protocol	1	Appendix II Surveys
Evaluator Protocol	1	Appendix II Surveys

---

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	351	0	0	351	0	0
Annual Time Burden (Hours)	192	0	0	192	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: New collection.

---

Annual Cost to Federal Government: $105,000

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]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Yes

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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: 03/17/2015

---