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 Survey of Refugee Health Coordinators	Form and Instruction	New	Available
Form 1 Service Delivery Feedback Form	Form and Instruction	New	Available
Form 1 Unit 6 Pre Test Final	Form and Instruction	New	Available
Form 1 Unit 6 Post-Test Final	Form and Instruction	New	Available
Form 1 Unit 5 Pre Test Final	Form and Instruction	New	Available
Form 1 Unit 5 Post Test Final	Form and Instruction	New	Available
Form 1 Unit 4 Pre Test Final	Form and Instruction	New	Available
Form 1 Unit 4 Post-Test Final	Form and Instruction	New	Available
Form 1 Unit 3 Pre Test Final	Form and Instruction	New	Available
Form 1 Unit 3 Post-Test Final	Form and Instruction	New	Available
Form 1 Unit 2Pre Test Final	Form and Instruction	New	Available
Form 1 Unit 2 Post Test Final	Form and Instruction	New	Available
Form 1 Unit Post Test Final	Form and Instruction	New	Available
Form 1 Participant Experience Survey Final	Form and Instruction	New	Available
Form 1 Instructor Unit Survey Final	Form and Instruction	New	Available
Form 1 Instructor Unit Survey	Form and Instruction	New	Available
Form 1 Instructor Experience Survey Final	Form and Instruction	New	Available
Form 1 EBPAS-36	Form and Instruction	New	Available
Form 1 Website Feedback	Form and Instruction	New	Available
Form 1 Survivor Fellow Feedback	Form and Instruction	New	Available
Form 1 Survivor Fellow Feedback	Form and Instruction	New	Available
Form 1 Specialized TTA Feedback	Form and Instruction	New	Available
Form 1 Short Term TTA Feedback	Form and Instruction	New	Available
Form 1 ScholarshipAoplicant	Form and Instruction	New	Available
Form 1 Scholarship Applicant Org	Form and Instruction	New	Available
Form 1 OTIP Grantee Feedback	Form and Instruction	New	Available
Form 1 HT Fellowship PREP Program	Form and Instruction	New	Available
Form 1 HTFellowship POST Program	Form and Instruction	New	Available
Form 1 General Conference Feeback	Form and Instruction	New	Available
Form 1 Conference Session Feedback	Form and Instruction	New	Available
Form 1 Call Center Feedback	Form and Instruction	New	Available
Form 1 Advisory Committee Feedback	Form and Instruction	New	Available
Form 1 WebinarParticipant	Form and Instruction	New	Repair queued
Form 1 SOAR SpcializedTTA	Form and Instruction	New	Available
Form 1 SOAR Organizational Feedback	Form and Instruction	New	Available
Form 1 SOAR Online Participant Form	Form and Instruction	New	Available
Form 1 SOAR Conference	Form and Instruction	New	Available
Form 1 SOAR Blended Learning Participant Form	Form and Instruction	New	Available
Form 1 ResourceTool	Form and Instruction	New	Available
Form 1 RequesterFeedback	Form and Instruction	New	Available
Form 1 Pilot	Form and Instruction	New	Available
Form 1 Interview Guide	Form and Instruction	New	Available
Form 1 GeneralTraining	Form and Instruction	New	Available
Form 1 Followup	Form and Instruction	New	Available
Form 1 FocusGroupGuide	Form and Instruction	New	Available
Form 1 FG Demographic Survey	Form and Instruction	New	Repair queued
Form 1 Coordination	Form and Instruction	New	Available
Form 1 Consultant	Form and Instruction	New	Available
Form 1 Feedback Form	Form and Instruction	New	Available
Form 1 Adoption Triad	Form and Instruction	New	Available
Form 1 ANA Survey	Form and Instruction	New	Available
Form 1 TA State Systems Network Feedback	Form and Instruction	Unchanged	Available
Form 1 Meeting Facilitation	Form and Instruction	Unchanged	Available
Form 1 Administrator Feedback Collection	Form and Instruction	Unchanged	Available
Form 1 SCBC Task 3	Form and Instruction	Unchanged	Available
Form 1 Follow-up Needsw Assessment Feedback Form	Form and Instruction	Unchanged	Available
Form 1 Institute Feedback Form	Form and Instruction	Unchanged	Available
Form 1 SCBC Task 2	Form and Instruction	Unchanged	Available
Form 1 IC for 2017 ACF Grantee Meeting	Form and Instruction	Unchanged	Available
Form 1 DCP Stakeholder Interview Guide	Form and Instruction	Unchanged	Available
Form 1 OTIP DCP Survey Questionnaire	Form and Instruction	Unchanged	Available
Form 1 3 Year Posst Project Survey	Form and Instruction	Unchanged	Available
Form 1 AFI Instruction and Instruments.	Form and Instruction	Unchanged	Repair queued
Form 1 ECLKC Tree Testing Script	Form and Instruction	Unchanged	Available
Form 1 ANA TTA Survey Questions	Form and Instruction	Unchanged	Available
Form 1 ANA Comms Survey Questions Survey Monkey	Form and Instruction	Unchanged	Available
Form 1 NDMI Live Learning Event Survey	Form and Instruction	Unchanged	Available
Form 1 Fast Track Toolkit Survey Instrument	Form and Instruction	Unchanged	Available
Form 1 Grantee Workshop Survey Instrument	Form and Instruction	Unchanged	Available
Form 1 PMFO Fiscal Consulting Survey	Form and Instruction	Unchanged	Repair queued
Form 1 CapLearn registration fields	Form and Instruction	Unchanged	Available
Form 1 VirtualConference FocusGroupGuide	Form and Instruction	Unchanged	Available
Form 1 Fiscal Consulting Survey	Form and Instruction	Unchanged	Available
Form 1 Event Session Survey	Form and Instruction	Unchanged	Available
Form 1 PMFO Conference Survey	Form and Instruction	Unchanged	Available
Form 1 SOAR End-of-Course Evaluation	Form and Instruction	Unchanged	Available
Form 1 Generic Request	Form and Instruction	Unchanged	Available
Form 1 Exit Survey	Form and Instruction	Unchanged	Available
Form 1 Justification	Form and Instruction	Unchanged	Available
Form 1 OTIP Fast Track Request	Form and Instruction	Unchanged	Available
Form 1 NFCAD Survey	Form and Instruction	Unchanged	Available
Form 1 Center for States Needs Assessment Survey 2016	Form and Instruction	Unchanged	Available
Form 1 AFI Outreach Instruments	Form and Instruction	Unchanged	Available
Form 1 Fatherhood Screener Comm Check	Form and Instruction	Unchanged	Available
Form 1 CWIG Special Inititiative Survey for OMB 1-20-16	Form and Instruction	Unchanged	Available
Form 1 VT BICS Draft Questionaire 2-8-16	Form and Instruction	Unchanged	Available
Form 1 Media Consumption Survey Instrument	Form and Instruction	Unchanged	Available
Form 1 Fast Track Instrument	Form and Instruction	Unchanged	Available
Form 1 CED Grantee Needs Assessmenr	Form and Instruction	Unchanged	Available
Form 1 Special Initiative Survey	Form and Instruction	Unchanged	Available
Form 1 Capacity Building Collaborative Customer Feedback Instrument	Form and Instruction	Unchanged	Available
Form 1 AFI Outreach Assessment	Form and Instruction	Unchanged	Repair queued
Form 1 Capacity Building Collaborative Customer Feedback Instrument	Form and Instruction	Unchanged	Available
Form 1 Center for States Intensive Capacity Building Project	Form and Instruction	Unchanged	Available
Form 1 AFI Capacity Building Visit Feedback Form	Form and Instruction	Unchanged	Available
Form 1 National Responsible Fatherhood Clearinghouse (NRFC)	Form and Instruction	Unchanged	Available
Form 1 FEI Website Survey	Form and Instruction	Unchanged	Available
Form 1 Focus Group	Form and Instruction	Unchanged	Available
Justification for Increase in Fast Track Burden Ceiling 5-17.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-05-31	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
229920	Maternal, Infant, and Early Childhood Home Visiting (MIECHV) TA Satisfaction Survey	Other-Survey	New
229919	Regugee Health Coordinator Survey	Form and Instruction	New	Survey of Refugee Health Coordinators
229876	Feedback on the "Looking forward to the 2019 National Survey of Early Care and Education" webinar	Other-Customer Feedback	New
229784	Comment Form: Fatherhood Research and Practice Network Learning Community	Other-Comment Card	New
229778	Customer feedback focus group with Healthy Marriage and Relationship Education (HMRE) program staff	Other-Focus Group	New
229777	Meeting Evaluation Form - CCDBG Implementation Research and Evaluation Planning Grantees	Other-Survey	New
229704	Region XII Migrant and Seasonal Head Start T/TA Service Delivery Feedback	Form and Instruction	New	Service Delivery Feedback Form
229636	Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Continuous Quality Improvement (CQI) Practicum Feedback Questions	Other-Survey	New
229632	Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2018 Annual Meeting	Other-Evaluation form	New
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Unit 6 Pre Test Final
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Unit 6 Post-Test Final
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Unit 5 Pre Test Final
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Unit 5 Post Test Final
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Unit 4 Pre Test Final
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Unit 4 Post-Test Final
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Unit 3 Pre Test Final
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Unit 3 Post-Test Final
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Unit 2Pre Test Final
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Unit 2 Post Test Final
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Unit Post Test Final
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Participant Experience Survey Final
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Instructor Unit Survey Final
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Instructor Unit Survey
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	Instructor Experience Survey Final
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New	EBPAS-36
229526	Rigorous Evaluation Technical Assistance (RETA) Feedback Form	Other-Word template	New
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New	Website Feedback
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New	Survivor Fellow Feedback
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New	Survivor Fellow Feedback
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New	Specialized TTA Feedback
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New	Short Term TTA Feedback
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New	ScholarshipAoplicant
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New	Scholarship Applicant Org
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New	OTIP Grantee Feedback
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New	HT Fellowship PREP Program
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New	HTFellowship POST Program
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New	General Conference Feeback
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New	Conference Session Feedback
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New	Call Center Feedback
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New	Advisory Committee Feedback
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	WebinarParticipant
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	SOAR SpcializedTTA
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	SOAR Organizational Feedback
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	SOAR Online Participant Form
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	SOAR Conference
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	SOAR Blended Learning Participant Form
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	ResourceTool
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	RequesterFeedback
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	Pilot
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	Interview Guide
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	GeneralTraining
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	Followup
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	FocusGroupGuide
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	FG Demographic Survey
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	Coordination
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	Consultant
228681	ANA Language Summit Survey	Other-Survey	New
228217	OHS TTA Network Training Feedback Form	Form and Instruction	New	Feedback Form
227797	Center for States Needs Assessment 2017	Instruction	New
227438	Adoption Triad Survey	Form and Instruction	New	Adoption Triad
227436	ANA Post Peer Panel Review Survey	Form and Instruction	New	ANA Survey
226904	OAS-TA State Systems Specialist Network Feedback	Form and Instruction	Unchanged	TA State Systems Network Feedback
226903	OAS-On-Site Meeting Facilitation State Feedback Collection	Form and Instruction	Unchanged	Meeting Facilitation
226902	OAS-Administrator Feedback Collection	Form and Instruction	Unchanged	Administrator Feedback Collection
226898	OAS-TA Feedback Collection for Infant Toddler	Form and Instruction	Unchanged	SCBC Task 3
226784	Follow-Up Needs Assessment Feedback Form	Form and Instruction	Unchanged	Follow-up Needsw Assessment Feedback Form
226782	Institute Feedback Form	Form and Instruction	Unchanged	Institute Feedback Form
226773	OAS-Specialized Resources TA Feedback Collection	Form and Instruction	Unchanged	SCBC Task 2
226527	Soliciatation of Opinions for 2017 ACF Native American Grantee Meeting	Form and Instruction	Unchanged	IC for 2017 ACF Grantee Meeting
226463	Human Trafficking Data Collection Pilot	Form and Instruction	Unchanged	DCP Stakeholder Interview Guide
226463	Human Trafficking Data Collection Pilot	Form and Instruction	Unchanged	OTIP DCP Survey Questionnaire
226361	ANA Sustainablility Servicers Survey	Form and Instruction	Unchanged	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	Unchanged
225714	Feedback on Mother and Infant Home Visiting Program Evaluation (MIHOPE) Long-term Follow-up study design options	Other-Discussion Questions	Unchanged
225618	Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2017 Annual Meeting	Other-Survey	Unchanged
225050	ACF Office of Regional Operations Customer Feedback for Learning Experiences	Other-Survey	Unchanged
224993	OCS-AFI Application Readiness Assessment Questions for Cohert Participants	Form and Instruction	Unchanged	AFI Instruction and Instruments.
224990	HS-ECLKC Tree Testing	Form and Instruction	Unchanged	ECLKC Tree Testing Script
224679	ANA Training and Technical Assistance Services Survey	Form and Instruction	Unchanged	ANA TTA Survey Questions
224610	MIECHV Grantee Feedback on Data and Evaluation Technical Assistance	Other-Small group discussion	Unchanged
224345	ANA 2016 Communication Survey	Form and Instruction	Unchanged	ANA Comms Survey Questions Survey Monkey
223858	PMFO New Director Mentor Iniative	Form and Instruction	Unchanged	NDMI Live Learning Event Survey
223811	Input on Agenda for 2017 Annual Meeting of Child Care and Early Education Policy Research Consortium	Other-Survey	Unchanged
223686	AFI Capacity Building Toolkit Usability Test	Form and Instruction	Unchanged	Fast Track Toolkit Survey Instrument
223591	AFI Grantee Workshop Evaluation Survey	Form and Instruction	Unchanged	Grantee Workshop Survey Instrument
223533	PMFO Fiscal Consulting Inititative Feedback Survey	Form and Instruction	Unchanged	PMFO Fiscal Consulting Survey
223306	CWCB CapLEARN	Form and Instruction	Unchanged	CapLearn registration fields
223215	Child Welfare Capacity Building Collaborative Focus Group	Form and Instruction	Unchanged	VirtualConference FocusGroupGuide
223172	OHS-Fiscal Consulting Survey	Form and Instruction	Unchanged	Fiscal Consulting Survey
223170	OHS-Event Session Survey	Form and Instruction	Unchanged	Event Session Survey
223166	OHS-Conference Feedback Survey	Form and Instruction	Unchanged	PMFO Conference Survey
223017	SOAR Human Trafficking Training End-of-Course Evaluation	Form and Instruction	Unchanged	SOAR End-of-Course Evaluation
222295	Virtual Conference Session Evaluation	Form and Instruction	Unchanged	Generic Request
222294	CWIG Virtual Conference Exit Survey	Form and Instruction	Unchanged	Exit Survey
221800	SOAR End of Course Evaluation	Form and Instruction	Unchanged	Justification
221738	OTIP	Form and Instruction	Unchanged	OTIP Fast Track Request
221682	Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinars 3&4	Other-	Unchanged
221461	National Foster Care and Adoption Directory Survey	Form and Instruction	Unchanged	NFCAD Survey
221111	Center for States - 2015	Form and Instruction	Unchanged	Center for States Needs Assessment Survey 2016
220980	Investigation and Analysis of AFI	Form and Instruction	Unchanged	AFI Outreach Instruments
220065	Father Involvement Communication Checks	Form and Instruction	Unchanged	Fatherhood Screener Comm Check
220048	Child Welfare Information Gateways's Special Inititative Survey	Form and Instruction	Unchanged	CWIG Special Inititiative Survey for OMB 1-20-16
220018	BICS Vermont Grant Resolution Meeting Customer Satisfaction	Form and Instruction	Unchanged	VT BICS Draft Questionaire 2-8-16
220013	Center for States Media Consumption Survey	Form and Instruction	Unchanged	Media Consumption Survey Instrument
219984	Tribal MIECHV Data System Planning	Other-Survey	Unchanged
219933	Constituency Group Survey	Form and Instruction	Unchanged	Fast Track Instrument
219265	OCS CED Focus Group	Form and Instruction	Unchanged	CED Grantee Needs Assessmenr
219240	Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinar	Other-survey and polls	Unchanged
219077	Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting	Other-Feedback form	Unchanged
218714	Special Initiative Survey	Form and Instruction	Unchanged	Special Initiative Survey
218540	Capacity Building Collaborative Customer Feedback for Learning Experiences	Form and Instruction	Unchanged	Capacity Building Collaborative Customer Feedback Instrument
218317	AFI Outreach Survey	Form and Instruction	Unchanged	AFI Outreach Assessment
218119	Collaborative Customer Feedback	Form and Instruction	Unchanged	Capacity Building Collaborative Customer Feedback Instrument
218106	Comment Form: 2015 OPRE Innovative Methods Meeting	Other-Comment form	Unchanged
217606	Center for States	Form and Instruction	Unchanged	Center for States Intensive Capacity Building Project
217090	Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting	Other-Survey	Unchanged
216671	AFI Capacity Building Visit	Form and Instruction	Unchanged	AFI Capacity Building Visit Feedback Form
216659	Center for Urban Families (CFUF)	Form and Instruction	Unchanged	National Responsible Fatherhood Clearinghouse (NRFC)
216644	FEI Website Survey	Form and Instruction	Unchanged	FEI Website Survey
216642	FEI Focus Group	Form and Instruction	Unchanged	Focus Group

ICR Details

OMB Control No: 0970-0401	ICR Reference No: 201706-0970-005
Status: Historical Active	Previous ICR Reference No: 201705-0970-010
Agency/Subagency: HHS/ACF	Agency Tracking No: OPRE
Title: Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/05/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/29/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	05/31/2018	05/31/2018
Responses	44,124	0	14,124
Time Burden (Hours)	17,062	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: 76

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 Language Summit Survey
ANA Post Peer Panel Review Survey	1	ANA Survey
ANA Sustainablility Servicers Survey	1	3 Year Posst Project Survey
ANA Training and Technical Assistance Services Survey	1	ANA TTA Survey Questions
Adoption Triad Survey	1	Adoption Triad
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 States Needs Assessment 2017
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
Comment Form: Fatherhood Research and Practice Network Learning Community
Constituency Group Survey	1	Fast Track Instrument
Course Participant Knowledge Gain Assessment	1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1	EBPAS-36 ,   Instructor Experience Survey Final ,   Instructor Unit Survey ,   Instructor Unit Survey Final ,   Participant Experience Survey Final ,   Unit Post Test Final ,   Unit 2 Post Test Final ,   Unit 2Pre Test Final ,   Unit 3 Post-Test Final ,   Unit 3 Pre Test Final ,   Unit 4 Post-Test Final ,   Unit 4 Pre Test Final ,   Unit 5 Post Test Final ,   Unit 5 Pre Test Final ,   Unit 6 Post-Test Final ,   Unit 6 Pre Test Final
Customer feedback focus group with Healthy Marriage and Relationship Education (HMRE) program staff
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 Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2018 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
Feedback on the "Looking forward to the 2019 National Survey of Early Care and Education" webinar
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 Grantee Feedback on Data and Evaluation Technical Assistance
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Continuous Quality Improvement (CQI) Practicum Feedback Questions
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) TA Satisfaction Survey
Meeting Evaluation Form - CCDBG Implementation Research and Evaluation Planning Grantees
National Foster Care and Adoption Directory Survey	1	NFCAD Survey
National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1	Consultant ,   Coordination ,   FG Demographic Survey ,   FocusGroupGuide ,   Followup ,   GeneralTraining ,   Interview Guide ,   Pilot ,   RequesterFeedback ,   ResourceTool ,   SOAR Blended Learning Participant Form ,   SOAR Conference ,   SOAR Online Participant Form ,   SOAR Organizational Feedback ,   SOAR SpcializedTTA ,   WebinarParticipant
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 TTA Network Training Feedback Form	1	Feedback Form
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
OTIP NHTTAC General Fast Track	1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1	Advisory Committee Feedback ,   Call Center Feedback ,   Conference Session Feedback ,   General Conference Feeback ,   HTFellowship POST Program ,   HT Fellowship PREP Program ,   OTIP Grantee Feedback ,   Scholarship Applicant Org ,   ScholarshipAoplicant ,   Short Term TTA Feedback ,   Specialized TTA Feedback ,   Survivor Fellow Feedback ,   Survivor Fellow Feedback ,   Website Feedback
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
Region XII Migrant and Seasonal Head Start T/TA Service Delivery Feedback	1	Service Delivery Feedback Form
Regugee Health Coordinator Survey	1	Survey of Refugee Health Coordinators
Rigorous Evaluation Technical Assistance (RETA) Feedback Form
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	44,124	14,124	0	0	30,000	0
Annual Time Burden (Hours)	17,062	7,062	0	0	10,000	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: 06/29/2017

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