Information Collection

Fatherhood and Marriage Local Evaluation and Cross-Site Services Components

IC 239888 under ICR 202012-0970-002 · OMB 0970-0356.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0356 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 1 - FaMLE Impact Report Template.docx	Other-Template
Instrument 2 - FaMLE Impact Report Table Shells.docx	Other-Table Shells
Instrument 3 - FaMLE Descriptive Report Template.docx	Other-Template
Instrument 4 - FaMLE Descriptive Report Table Shells.docx	Other-Table Shells
Supporting Statement A - FaMLE final report_clean.docx Supporting Statement A - FaMLE Final Report	IC Document
Supporting Statement B - FaMLE final report_clean.docx Supporting Statement B - FaMLE final report_clean.docx	IC Document
Appendix A - FaMLE Impact Report Instructions.docx Appendix A - FaMLE Impact Report Instructions	IC Document
Appendix B - FaMLE Descriptive Report Instructions.docx Appendix B - FaMLE Descriptive Report Instructions	IC Document

IC Title:

Fatherhood and Marriage Local Evaluation and Cross-Site Services Components

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Template	Instrument 1 - FaMLE Impact Report Template.docx	Yes	Yes	Fillable Fileable
Other-Table Shells	Instrument 2 - FaMLE Impact Report Table Shells.docx	Yes	Yes	Fillable Fileable
Other-Template	Instrument 3 - FaMLE Descriptive Report Template.docx	Yes	Yes	Fillable Fileable
Other-Table Shells	Instrument 4 - FaMLE Descriptive Report Table Shells.docx	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 34

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	34	34
Annual IC Time Burden (Hours)	1,360	1,360
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A - FaMLE Final Report	Supporting Statement A - FaMLE final report_clean.docx	02/10/2020
Supporting Statement B - FaMLE final report_clean.docx	Supporting Statement B - FaMLE final report_clean.docx	02/10/2020
Appendix A - FaMLE Impact Report Instructions	Appendix A - FaMLE Impact Report Instructions.docx	02/10/2020
Appendix B - FaMLE Descriptive Report Instructions	Appendix B - FaMLE Descriptive Report Instructions.docx	02/10/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.