Form 1 OCC OMB SCBC Task 4 Impact Instrument

TITLE OF INFORMATION COLLECTION: State Capacity Building Center Tailored TA Feedback Collection for Impact Project

Impact Project Email Invitation

The Impact Project Report provides an opportunity for Impact Project States to provide feedback regarding their experience so far. There are 7 questions to gather your feedback on our assistance so far.

As you complete the Progress Report, you can save your responses and come back later. To save your responses, please be sure to hit the "Save and Continue" button on the bottom of the page that you are working on before you close out.

Please complete this report by XXXX. If you have any questions, contact [email protected].

Feedback Form

OMB Control No: 0970-0401

Expiration date: 05/31/2021

Instructions

The Impact Project Progress Report provides an opportunity for Impact Project States to share their progress and provide feedback regarding their experience so far. There are 7 questions to gather your feedback on our assistance so far.

As you complete the Progress Report, you can save your responses and come back later. To save your responses, please be sure to hit the "Save and Continue" button on the bottom of the page that you are working on before you close out.

NOTE: THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13). Public reporting burden for this collection of information is estimated to average 15 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.

Introduction

Please select your State/Territory

• Commonwealth of the Northern Mariana Islands

• Florida

• Indiana

• North Dakota

• New Hampshire

• Oregon

• South Carolina
  
  
  

Responsiveness

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
The consultant is responsive to our needs.	1	2	3	4	N/A
The consultant is helping us solve problems.	1	2	3	4	N/A

Quality of Products and Services

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
The consultant has provided the services and/or products we requested.	1	2	3	4	N/A
The products and/or services are of high quality.	1	2	3	4	N/A

Quality of Impact Project Consultant

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
We are satisfied with the consultants' approach to working with our team.	1	2	3	4	N/A
The consultant has the experience, knowledge, and ability to support our project.	1	2	3	4	N/A
The consultant understand our state context and culture.	1	2	3	4	N/A

Work with the Impact Project Consultant Related to Project Planning, Coordination, and Implementation

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
The consultant has helped us identify priorities and clear action steps for our Impact Project.	1	2	3	4	N/A
The consultant has suggested strategic next steps and/or helped us begin to implement improved strategies.	1	2	3	4	N/A
The consultant has connected us to resources (internal or external) that will help us more easily access answers/ solutions in the future.	1	2	3	4	N/A
The consultant has Influenced our overall approach to our project.	1	2	3	4	N/A

The Impact Project involves support for your capacity building efforts. Thinking about your capacity building work for the Impact Project, do you need more attention to any of the capacity factors? Select all that apply.

• Culture & Climate (The Management Team has the culture and climate capacity necessary for developing and implementing their identified project goals and strategies)

• Engagement and Partnerships (The Management Team has the partnerships and engagement capacity necessary for implementing the project, and achieving success. Decisions are informed by and responsive to the needs and interests of a broad array of stakeholders)

• Financial Resources (The Management Team has the capacity to leverage and maximize all available resources necessary for implementing their identified project. The Management Team considers how financing decisions support and incentivize system building goals connected with the project)

• Infrastructure (The Management Team has the infrastructure capacity necessary for implementing their identified project, including leadership, vision and cohesion. The management team is working together according to shared understanding of common goals and what their roles and functions are within the project and system. The management team has established processes for ongoing communication, coordination, and decision-making as they relate to achieving their shared goals)

• Knowledge & Skills (The Management Team has the systems leadership capacity necessary for implementing their identified project)

• Other (please specify)

Technical Assistance Coordination

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
The consultant has coordinated TA with our State Systems Specialist and/or Infant Toddler Specialist to support our project.	1	2	3	4	N/A
The consultant has coordinated TA with additional TA Centers (e.g., the ACF National TA Centers) that align with our project.	1	2	3	4	N/A

If you selected “strongly disagree” or “disagree” for any of the statements above, please tell us why.

Which aspect(s) have been most useful to you?

How could we better meet your needs?

Paperwork Reduction Act Statement: This collection of information is voluntary and will be used to collect participant feedback to shape future OCC technical assistance services. 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. The OMB number and expiration date for this collection are OMB #: 0970-0401, Exp: 05/31/2018. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to J.R.Sayoc, j.r.sayoc@icfcom

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