Fidelity

OMB Approval # 0990-0XXX

Expiration Date: XX/XX/2018

Fidelity

Facilitator reported fidelity

• For every curriculum session, what is the date, what is the number of activities planned and what is the number of activities completed?

There are 2 performance measures for fidelity to be reported to the agency that will be calculated using the facilitator reported fidelity:

• The median percentage of activities completed across sessions, summarized by grant type and tier

• The median percentage of sessions implemented

Observer reported fidelity

• For each of 10%¹ of curriculum sessions, what is the number of activities planned and what is the number of activities completed?

There are 2 performance measures of fidelity to be reported to the agency (and to Congress) that will be calculated using the observer reported fidelity:

• The percentage of sessions actually observed by an independent observer, summarized by grant type and tier.

• The median percentage of activities (and minimum and maximum) completed across sessions as observed, summarized by grant type and tier.

Observer reported quality (see form in Appendix D).

There is 1 performance measure of observer quality to be reported to the agency (and to congress) that will be calculated using the observer reported quality:

• The percentage of sessions receiving a rating of at least 4 for overall quality, summarized by grant type and tier.

1 For the Tier 1B grantees in the maximum funding category, 5% curriculum sessions would be observed

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0XXX. The time required to complete this information collection is estimated to average 1.7 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer.