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Federal forms, ICRs, and supporting documents

Information Collection

Family Level Assessment and State of Home Visiting (FLASH-V) - Formative Data Collection

IC 229732 under ICR 201711-0970-008 · OMB 0970-0356.

Documents and Forms
Document Name
Document Type
Other-Eligibility Assessment Form
Other-Outreach and Scheduling
Other-Interview Protocol – LIA
Other-Interview Protocol – Centraliz
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Family Level Assessment and State of Home Visiting (FLASH-V) - Formative Data Collection
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Eligibility Assessment Form 1 - Eligibility Assessment Form.xlsm Yes Yes Fillable Fileable
Other-Outreach and Scheduling 2 - Outreach to LIAs and CIs, Assessing Eligibility, and Scheduling Interviews.docx No   Paper Only
Other-Interview Protocol – LIA 3 - Interview Protocol_LIA.docx No   Paper Only
Other-Interview Protocol – Centralized Intake Agency 4 - Interview Protocol_Centralized Intake Agency.docx No   Paper Only

Community and Social Services Social Services

 

118 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 118 0 118 0 0 0
Annual IC Time Burden (Hours) 57 0 57 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
FLASH-V Formative Generic - Supporting Statement A FLASH-V SSA Template - Formative Generics 010918.doc 01/12/2018
FLASH-V Formative Generic - Supporting Statement B FLASH-V SSB Template - Formative Generics 010918.doc 01/12/2018
Appendix A - Outreach to State Grantees Appendix A - Outreach to State Grantees.docx 01/12/2018
Appendix B - Project Description Appendix B - Project Description.docx 01/12/2018
Appendix C - Informed Consent Appendix C - Informed Consent.docx 01/12/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.