Preventing and Addressing Intimate Violence when Engaging Dads (PAIVED)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
PAIVED SSB_5-16-18.docx	Supporting Statement B	Uploaded 2018-05-16	Available
Attachment 4 PAIVED 60 Day FRN_2.8.18.pdf	Supplementary Document	Uploaded 2018-05-15	Available
Appendix F Thank You for Participating Script PAIVED_5.10.18.docx	Supplementary Document	Uploaded 2018-05-15	Available
Appendix E Reminder Scripts Site Visit and Interviews PAIVED_5.10.18.docx	Supplementary Document	Uploaded 2018-05-15	Repair queued
Appendix D PAIVED Recruitment and Logistics Email and Phone Scripts_5.10.18.docx	Supplementary Document	Uploaded 2018-05-15	Available
Appendix C Screening Matrix PAIVED Site Visits_5.10.18.docx	Supplementary Document	Uploaded 2018-05-15	Available
Appendix B Introduction to PAIVED Study Email and Phone Scripts_5.10.18.docx	Supplementary Document	Uploaded 2018-05-15	Available
Appendix A Consent Form PAIVED Interviews_5.10.18.docx	Supplementary Document	Uploaded 2018-05-15	Available
PAIVED SSA_5-10-18.docx	Supporting Statement A	Uploaded 2018-05-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
231461	PAIVED Partner Organization Interview Protocol	Other-Interview	New
231460	PAIVED RF Program Staff Interview Protocol	Other-Interview	New
231459	PAIVED interview and site visit screener	Other-screener	New

ICR Details

OMB Control No: 0970-0516	ICR Reference No: 201805-0970-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Preventing and Addressing Intimate Violence when Engaging Dads (PAIVED)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/18/2018
	Date Received in OIRA: 05/18/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2019	12 Months From Approved
Responses	90	0	0
Time Burden (Hours)	111	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services (HHS) seeks approval for information collection (IC) activities as part of their effort to better understand the services that federally and non-federally funded Responsible Fatherhood (RF) programs are providing or could provide to address and help prevent intimate partner violence (IPV) among their participants. This is a descriptive study. Collected data will be used to describe RF programming, including IPV-related content, and partners and to inform recommendations, resources, and trainings for best addressing IPV in RF programming. This new data collection involves: semi-structured interviews – either in-person during site visits or via telephone – with up to 25 RF program staff (Program Directors and Program Facilitators) and up to 15 Partner Organizations/Providers, and program observations. IC will focus on RF programs with diverse target populations and IPV services, from a range of geographic locations. The program observations do not impose any respondent burden.

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Authorizing Statute(s): None

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:
	83 FR 5630	02/08/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 23281	05/18/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
PAIVED interview and site visit screener
PAIVED RF Program Staff Interview Protocol
PAIVED Partner Organization Interview Protocol

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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	90	0	0	90	0	0
Annual Time Burden (Hours)	111	0	0	111	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new data collection.

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Annual Cost to Federal Government: $93,500

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 05/18/2018

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