AFI OMB Justification Package - Attachments A-K

SUPPORTING STATEMENT FOR THE

ASSETS FOR INDEPENDENCE (AFI)

PROGRAM EVALUATION

ATTACHMENTS

OMB No. 0970-0414

Office of Planning, Research, and Evaluation

Administration for Children and Families

U.S. Department of Health and Human Services

370 L'Enfant Promenade, SW

Washington, DC 20447

Contract Number HHSP23320095654WC

Order Number HHSP23337032T

August 2015

Table of Contents

ATTACHMENT A Federal-Wide Assurance

ATTACHMENT B Confidentiality Agreement

ATTACHMENT C Minimum Detectable Effect

ATTACHMENT D Site Management Screens

ATTACHMENT E Panel Maintenance Mailing Materials

ATTACHMENT F Field Locating Materials

ATTACHMENT G Lead Letter

ATTACHMENT H Follow-Up Survey Introduction

ATTACHMENT I 36-Month Follow-Up Survey Incentive Letter

ATTACHMENT J 60-Day Federal Register Notice

ATTACHMENT K References

Attachment A

Federal-Wide Assurance

SECTION 301 OF THE PUBLIC HEALTH SERVICE ACT (42 USC 241)

TITLE III – GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

PART A – RESEARCH AND INVESTIGATION

IN GENERAL

Sec. 301 [Sec. 241] (a) The Secretary shall conduct in the Service, and encourage, cooperate with, and render assistance to other appropriate public authorities, scientific institutions, and scientists in the conduct of, and promote the coordination of, research, investigations, experiments, demonstrations, and studies relating to the causes, diagnosis, treatment, control, and prevention of physical and mental diseases and impairments of man, including water purification, sewage treatment, and pollution of lakes and streams. In carrying out the foregoing the Secretary is authorized to -

• collect and make available through publications and other appropriate means, information as to, and the practical application of, such research and other activities;

• make available research facilities of the Service to appropriate public authorities, and to health officials and scientists engaged in special study;

• make grants-in-aid to universities, hospitals, laboratories, and other public or private institutions, and to individuals for such research projects as are recommended by the advisory council to the entity of the Department supporting such projects and make, upon recommendation of the advisory council to the appropriate entity of the Department, grants-in-aid to public or nonprofit universities, hospitals, laboratories, and other institutions for the general support of their research;

• secure from time to time and for such periods as he deems advisable, the assistance and advice of experts, scholars, and consultants from the United States or abroad;

• for purposes of study, admit and treat at institutions, hospitals, and stations of the Service, persons not otherwise eligible for such treatment; make available, to health officials, scientists, and appropriate public and other nonprofit institutions and organizations, technical advice and assistance on the application of statistical methods to experiments, studies, and surveys in health and medical fields;

• enter into contracts, including contracts for research in accordance with and subject to the provisions of law applicable to contracts entered into by the military departments under sections 2353 and 2354 of title 10, except that determination, approval, and certification required thereby shall be by the Secretary of Health and Human Services; and,

• adopt, upon recommendations of the advisory councils to the appropriate entities of the Department or, with respect to mental health, the National Advisory Mental Health Council, such additional means as the Secretary considers necessary or appropriate to carry out the purposes of this section.

The Secretary may make available to individuals and entities, for biomedical and behavioral research, substances and living organisms. Such substances and organisms shall be made available under such terms and conditions (including payment for them) as the Secretary determines appropriate.

(b) (1) The Secretary shall conduct and may support through grants and contracts studies and testing of substances for carcinogenicity, teratogenicity, mutagenicity, and other harmful biological effects. In carrying out this paragraph, the Secretary shall consult with entities of the Federal Government, outside of the Department of Health and Human Services, engaged in comparable activities. The Secretary, upon request of such an entity and under appropriate arrangements for the payment of expenses, may conduct for such entity studies and testing of substances for carcinogenicity, teratogenicity, mutagenicity, and other harmful biological effects.

(2) (A) The Secretary shall establish a comprehensive program of research into the biological effects of low-level ionizing radiation under which program the Secretary shall conduct such research and may support such research by others through grants and contracts.

(B) The Secretary shall conduct a comprehensive review of Federal programs of research on the biological effects of ionizing radiation.

(3) The Secretary shall conduct and may support through grants and contracts research and studies on human nutrition, with particular emphasis on the role of nutrition in the prevention and treatment of disease and on the maintenance and promotion of health, and programs for the dissemination of information respecting human nutrition to health professionals and the public. In carrying out activities under this paragraph, the Secretary shall provide for the coordination of such of these activities as are performed by the different divisions within the Department of Health and Human Services and shall consult with entities of the Federal Government, outside of the Department of Health and Human Services, engaged in comparable activities. The Secretary, upon request of such an entity and under appropriate arrangements for the payment of expenses, may conduct and support such activities for such entity.

(4) The Secretary shall publish a biennial report which contains -

(A) a list of all substances ( i ) which either are known to be carcinogens or may reasonably be anticipated to be carcinogens and ( ii ) to which a significant number of persons residing in the United States are exposed;

(B) information concerning the nature of such exposure and the estimated number of persons exposed to such substances;

(C) a statement identifying (i) each substance contained in the list under subparagraph (A) for which no effluent, ambient, or exposure standard has been established by a Federal agency, and

(ii) for each effluent, ambient, or exposure standard established by a Federal agency with respect to a substance contained in the list under subparagraph (A), the extent to which, on the basis of available medical, scientific, or other data, such standard, and the implementation of such standard by the agency, decreases the risk to public health from exposure to the substance; and

(D) a description of (i) each request received during the year involved -

(I) from a Federal agency outside the Department of Health and Human Services for the Secretary, or

(II) from an entity within the Department of Health and Human Services to any other entity within the Department, to conduct research into, or testing for, the carcinogenicity of substances or to provide information described in clause (ii) of subparagraph (C), and (ii) how the Secretary and each such other entity, respectively, have responded to each such request.

(5) The authority of the Secretary to enter into any contract for the conduct of any study, testing, program, research, or review, or assessment under this subsection shall be effective for any fiscal year only to such extent or in such amounts as are provided in advance in appropriation Acts.

(c) The Secretary may conduct biomedical research, directly or through grants or contracts, for the identification, control, treatment, and prevention of diseases (including tropical diseases) which do not occur to a significant extent in the United States.

(d) Protection of privacy of individuals who are research subjects. The secretary may authorize persons engaged in biomedical, behavioral, clinical, or other research (including research on mental health, including research on the use and effect of alcohol and other psychoactive drugs) to protect the privacy of individuals who are the subject of such research by withholding from all persons not connected with the conduct of such research the names or other identifying characteristics of such individuals. Persons so authorized to protect the privacy of such individuals may not be compelled in any federal, state, or local civil, criminal, administrative, legislative, or other proceedings to identify such individuals

Attachment B

Confidentiality Agreement for Research Staff

CONFIDENTIALITY AGREEMENT

I, (print employee’s name), an employee of (print employee’s organization), agree to work on the Assets for Independence (AFI) Program Evaluation in accordance with the guidelines and restrictions specified below. I understand that compliance with the terms of this agreement is a condition of my assignment with the Assets for Independence (AFI) Program Evaluation and that these terms are supplementary to those listed in my contract of employment with

(print employee’s organization).

a. I agree to treat as confidential all case-specific information obtained in the Assets for Independence (AFI) Program Evaluation and related matters. I further agree that this covenant of confidentiality shall survive the termination of this agreement.

b. I further understand that failure to follow the guidelines below may result in potential Institute disciplinary action, including termination. To fulfill confidentiality obligations, I will:

1. Discuss confidential project information only with authorized employees of the Assets for Independence (AFI) Program Evaluation.

2. Store confidential project information as specified by project protocols.

3. Safeguard combinations, keys, and rooms that secure confidential project information.

4. Safeguard confidential project information when in actual use.

5. Immediately report any alleged violations of the security procedures to my immediate supervisor.

6. Not photocopy or record by any other means any confidential project information unless authorized by project leaders or my supervisor.

7. Not in any way compromise the confidentiality of project participants.

8. Not allow access to any confidential project information to any unauthorized person.

9. Report any lost or misplaced confidential project information to my supervisor immediately.

Employee’s Signature _____________________________Date __________________

Employee’s Organization _______________________________

Attachment C

Minimum Detectable Effects

Minimum Detectable Effects for Impact Estimates at Follow-up Month 36
(Total Sample: Approximately 400 Cases in Sites 1 and 2, Respectively)
			RISE (Los Angeles):	CNM (New Mexico):	Pooled:
Total sample (A and B)	513			301	814
			Number of cases at entry
A: Treatment			257	152	409
B: Control			256	149	405
			Completed interviews: 80%
A: Treatment			206	122	328
B: Control			205	119	324
			Minimum detectable effect*
Comparison
A versus B (5 percent significance)			0.136	0.177	0.109
A versus B (10 percent significance)			0.121	0.157	0.097

Attachment D

Site Management Screens

OMB #: 0970-XXXX

Expiration Date: XX/XX/2015

OMB #: 0970-XXXX

Expiration Date: XX/XX/2015

Attachment E

Panel Maintenance Mailing Materials

ASSETS FOR INDEPENDENCE (AFI) PROGRAM EVALUATION

PANEL MAINTENANCE LETTER

OMB #: 0970-0414

Expiration Date: XX/XX/20XX

THE PAPERWORK REDUCTION ACT OF 1995:  Public reporting burden for this collection of information is estimated to average 60 minutes for the 36-month follow-up questionnaire, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

[DATE]

[FIRST NAME] [LAST NAME]

[ADDRESS]

[CITY], [STATE] [ZIP]

Dear [FIRST NAME],

A couple years ago, you applied for the Individual Development Account (IDA) program operated by the [FILL SITE NAME] and sponsored by the Department of Health and Human Services, Administration for Children and Families (ACF). At that time, you completed a survey on the computer, as well as a follow-up survey about 12 months later.

We are now preparing for the next survey beginning in [FILL MONTH AND YEAR] which will be conducted by telephone. For this program to be successful, it is important that we interview as many people who completed the computer survey as we can.

We are writing you now to make sure that we have your correct address and telephone number. We have enclosed a postage-paid envelope and a form for you to fill out.

Please know that your decision to provide contact information will not affect any services you receive. All information you provide will be kept private to the extent permitted by law, so your name will not be associated with the research findings from this project.

Although your participation in the study is completely voluntary, your opinions and experiences are of great value. If you have any questions about the form or about the study, please call Melissa Hobbs, the Data Collection Task Leader, toll-free at 1-800-334-8571 ext. 25744.

Thank you for your help.

Sincerely,

Dr. Gregory Mills

Project Director

Assets for Independence (AFI) Program Evaluation

THE PAPERWORK REDUCTION ACT OF 1995:  Public reporting burden for this collection of information is estimated to average 60 minutes for the 36-month follow-up questionnaire, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB #: 0970-0414

Expiration Date: XX/XX/20XX

[FILL SITE NAME]

AFI Program Evaluation Follow-up Study

Contact Information Update Form

Please review and return this form in the postage-paid envelope.

If your address and telephone number are correct please check the “Contact Information Correct” box. If your information has changed, please cross through anything that is incorrect and write your new information in the space below. If you plan to move and know your new address and telephone number, please enter it in the space below.

If you plan to move and do not know your new address and telephone number, please provide an address or phone number that we can use to reach you. For example, provide a work number or a cell phone number.

CURRENT CONTACT INFORMATION UPDATED CONTACT INFORMATION

[ID]

Best_R_Name

Best_R_addr

Best_R_city, Best_R_State, Best_R_zip5

TELEPHONE:Best_R_phone

CONTACT INFORMATION CORRECT 

Thank You!

Attachment F

Field Locating Materials

OMB #: 0970-XXXX

Expiration Date: XX/XX/20XX

THE PAPERWORK REDUCTION ACT OF 1995:  Public reporting burden for this collection of information is estimated to average 60 minutes for the 36-month follow-up questionnaire, , including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB #: 0970-XXXX

Expiration Date: XX/XX/20XX

THE PAPERWORK REDUCTION ACT OF 1995:  Public reporting burden for this collection of information is estimated to average 60 minutes for the 36-month follow-up questionnaire, , including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

THE PAPERWORK REDUCTION ACT OF 1995:  Public reporting burden for this collection of information is estimated to average 60 minutes for the baseline and follow-up questionnaires, for a total of 90 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB #: 0970-0414

Expiration Date: XX/XX/20XX

To whom it may concern:

This letter serves to authorize (FIELD LOCATOR NAME) to work as a field tracing representative on the Assets for Independence (AFI) Program Evaluation, sponsored by the Administration for Children and Families (ACF), an agency within the United States Department of Health and Human Services.

The field tracing representatives working on this study have been hired and trained specifically for this study by RTI International (RTI), a non-government survey organization located in Research Triangle Park, North Carolina. RTI is under contract (Contract # X) to ACF to perform all data collection activities associated with this survey.

If you would like further verification that (INTERVIEWER NAME) is a legitimate interviewer working for RTI on this study, please contact Ms. Melissa Hobbs at RTI (1-877-Xxx-xxxx, extension X, 8:30 AM to 5:00 PM, EST).

Thank you for your cooperation.

Sincerely,

Dr. Gregory Mills

Project Director

Assets for Independence (AFI) Program Evaluation

Attachment G

Lead Letter

ASSETS FOR INDEPENDENCE (AFI) PROGRAM EVALUATION

36-MONTH FOLLOW-UP LEAD LETTER –

CONTROL AND TREATMENT GROUP

THE PAPERWORK REDUCTION ACT OF 1995:  Public reporting burden for this collection of information is estimated to average 60 minutes for the 36-month follow-up questionnaire, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB #: 0970-0414

Expiration Date: XX/XX/20XX

[DATE]

[NAME]

[ADDRESS]

[CITY], [STATE] [ZIP]

Dear [FILL Name]:

CONTROL GROUP INTRODUCTION: Three years ago, you applied to the Individual Development Account (IDA) program operated by the [FILL SITE NAME]. Although you were not selected then to enter the program, you completed a self-administered computer survey and agreed to cooperate in an ongoing evaluation of the IDA program.

TREATMENT GROUP INTRODUCTION: Three years ago, you were selected to enter the Individual Development Account (IDA) program operated by the [FILL SITE NAME]. You also completed a self-administered computer survey and agreed to cooperate in an ongoing evaluation of the IDA program.

We thank you for agreeing to cooperate with this evaluation. The study will help policy makers learn about the impacts of individual development account programs on the lives of individuals and families.

Research Triangle Institute (RTI), located in North Carolina, is under contract with the Urban Institute and the U.S. Department of Health and Human Services to administer a telephone follow-up survey as part of the evaluation. One of our professional interviewers will call your house soon. If we call at a time that is not convenient for you, please tell us. We will be happy to set up a better time. The interview will take about 60 minutes. If you complete this survey within two weeks, you will receive $50.00 as a token of appreciation.

Please be assured that all of the information you provide will be kept private to the extent permitted by law, and we will never publish, release, or share your personal information with anyone outside of our research group. You should also know that your participation in this effort is completely voluntary.

If you have any questions about this study, please feel free to call Melissa Hobbs, the Data Collection Task Leader, toll-free at 1-800-334-8571 ext. 25744. If you have any questions or concerns about the privacy provisions of our study or your rights as a research participant, you may contact, anonymously if you wish, RTI's Office of Research Protection at 1-866-214-2043 or the Administrator of the Institutional Review Board at the Urban Institute, at [FILL NUMBER].

We look forward to speaking with you.

Sincerely,

Dr. Gregory Mills

Project Director

Assets for Independence (AFI) Program Evaluation

Attachment H

Follow-up Survey Introduction

ASSETS FOR INDEPENDENCE (AFI)

PROGRAM EVALUATION

AFI FOLLOW-UP QUESTIONNAIRE

INTERVIEWER WILL CONFIRM IDENTITY OF PARTICIPANT

INTRODUCTION

Hello, my name is ______________. I’m calling from RTI International, a research company in North Carolina, regarding the study of the Assets for Independence program operated by the [FILL SITE NAME]. Approximately 36 months ago, you applied for the [SITE NAME] IDA program. At that time, you completed a survey on the computer. We are calling now because we are conducting a follow-up study on behalf of the U.S. Department of Health and Human Services. Do you remember receiving a letter recently saying that someone would be contacting you to conduct a telephone interview?

IF YES: INTERVIEWER, READ FOLLOW-UP STUDY OVERVIEW. ANSWER QUESTIONS AS NEEDED.

IF NO: The letter stated that we are interested in interviewing you for this follow-up study. The interview will take about 60 minutes. All information you provide will be kept private to the extent permitted by law. If you complete this survey within two weeks, you will receive $50 as a token of appreciation.

FOLLOW-UP STUDY OVERVIEW

This telephone interview will include questions include your employment and financial experiences, residential status and satisfaction, lifestyle and health. The interview will take approximately 60 minutes. When we are done with the discussion, we will mail you $50 in appreciation for your time. This survey has been reviewed and approved by the Office of Management and Budget with OMB #: 0970-0414 which expires on XX/XX/20XX.

We are required to provide you with notice of the PAPERWORK REDUCTION ACT OF 1995:  Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

What you tell us is private and will be kept strictly private to the extent permitted by law. You should answer the interview questions in a private setting. The information will be used for research and statistical reports only.

Taking part in the study is completely voluntary. It is possible that you may find some of the survey questions are personal. However, you can choose not to answer any question and can stop at any time.

We may also contact you again in a couple years to take part in another follow-up survey.

Do you have any questions before we start?

IF YES: If you have any questions or concerns about the study, please call Melissa Hobbs, the Data Collection Task Leader, at 1-800-334-8571, 25744. If you have any questions about your rights as a study participant, you may call RTI’s Office of Research Protection at 1-866-214-2043 (a toll-free number) or call the Administrator of the Institutional Review Board at the Urban Institute, at X (a toll-free number).

IF NO: Good. Let’s begin.

Attachment I

36-Month Follow-up Survey Incentive Letter

ASSETS FOR INDEPENDENCE (AFI) PROGRAM EVALUATION

36-MONTH FOLLOW-UP INCENTIVE LETTER

THE PAPERWORK REDUCTION ACT OF 1995:  Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB #: 0970-0414

Expiration Date: XX/XX/20XX

[DATE]

[NAME]

[ADDRESS]

[CITY], [STATE] [ZIP]

Dear [NAME],

We want to thank you for taking the time to be interviewed for the Assets for Independence (AFI) Program Evaluation. The information you gave us will be very helpful in understanding the important role assets play in the lives of individuals and families. Please accept the enclosed gift as our way of thanking you.

Sincerely,

1-800-247-6056

Dr. Gregory Mills

Project Director

Assets for Independence (AFI) Program Evaluation

Attachment J

60-Day Federal Register Notice

4184-26

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Children and Families

Proposed Information Collection Activity; Comment Request

Title: Assets for Independence (AFI) Program Evaluation

OMB No.: 0970-0414

Description: The U.S. Department of Health and Human Services, Administration for Children and Families (ACF) is proposing a data collection activity as part of an experimental evaluation of the Assets for Independence (AFI) Program. The purpose of this study is to assess the impact of participation in AFI-funded individual development account (IDA) projects on the savings, asset purchases, and economic well-being of low-income individuals and families. The primary research question is: What is the impact of AFI project participation on outcomes such as savings, asset purchases, and material hardship?

While some evaluations suggest that IDAs help low-income families save, rigorous experimental research is limited. Few studies have focused on AFI-funded IDAs, and few have tested alternative design features.

The Assets for Independence Evaluation is the first experimental evaluation of IDA projects operating under the Assets for Independence Act, and will contribute importantly to understanding the effects of IDA project participation on project participants. The evaluation was launched in fall 2011 in two sites, with the random assignment of AFI-eligible cases to program and control groups. OMB approved three data collection efforts related to this project in October 2012, including approval of a baseline survey, 12-month follow-up survey, and implementation study protocols.

This Federal Register Notice provides the opportunity to comment on a proposed new information collection activity: the AFI Evaluation second follow-up survey (at 36 months post-random assignment) of both treatment and control group members. The purpose of the AFI Evaluation 36-month follow-up survey is to follow-up with study participants to document their intermediate savings and savings patterns, asset purchases, and other economic outcomes. The evaluation consists of both an impact study and an implementation study. Data collection activities will span a three-year period.

Data collection activities to submit in a future information collection request include a third follow-up survey for AFI Evaluation study participants approximately 60 months after study enrollment.

Respondents: Individuals enrolled in AFI programs, individuals who have left AFI programs, and control group members.

ANNUAL BURDEN ESTIMATES

Instrument	Total Number of Respondents	Annual Number of Respondents	Number of Responses Per Respondent	Average Burden Hours Per Response	Annual Burden Hours
Follow-Up Survey: AFI-eligible participants	814	271	1	0.5	136

Estimated Total Annual Burden Hours: 136

In compliance with the requirements of Section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Administration for Children and Families is soliciting public comment on the specific aspects of the information collection described above. Copies of the proposed collection of information can be obtained and comments may be forwarded by writing to the Administration for Children and Families, Office of Planning, Research and Evaluation, 370 L'Enfant Promenade, SW., Washington, DC 20447, Attn: OPRE Reports Clearance Officer. E-mail address: [email protected]. All requests should be identified by the title of the information collection.

The Department specifically requests comments on (a) whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; (b) the accuracy of the agency's estimate of the burden of the proposed collection of information; (c) the quality, utility, and clarity of the information to be collected; and (d) ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology. Consideration will be given to comments and suggestions submitted within 60 days of this publication.

________________

Karl Koerper Reports Clearance

Officer

Attachment L

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