OMB Control No: 1230-0NEW Expiration Date: XX/XX/20XX
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State-Level Collaboration Phase II Interview Questions
(1) Demographics of Participants
Agency type:
Vocational rehabilitation (VR)
Juvenile justice
Adult Justice/Department of Corrections
Child Welfare
Title I WIOA-funded Workforce
Title II WIOA Adult Education
Education
K-12
Higher Education
Career Technical Education
Other (Please describe): ___________________________________
Social security
Developmental disability
Mental health
Other (Please describe): ___________________________________
Total years of experience in the field: _______________
Total years of experience in your agency: _______________
Describe your role at your current agency:
Supervisory
Direct service provider
Both
Other (Please describe): ___________________________________
Describe the setting in which you or your agency provides services (check all that apply):
Urban
Suburban
Rural
Gender:
Female
Male
Non-binary
Prefer to self-describe: _______________________________
Prefer not to say
Do you consider yourself to be Hispanic/Latino?
Yes
No
Prefer to self-describe: _______________________________
Prefer not to say
Race – check all that apply:
African American
American Indian/Alaskan Native
Asian
Native Hawaiian/Pacific Islander
White
Prefer to self-describe: _______________________________
Prefer not to say
Do you have a disability?
Yes
No
Prefer to self-describe: _______________________________
Prefer not to say
Protocol for Interagency Collaboration in Youth Transition Interviews
Q# 1-11 For Agency Personnel in Supervisory Role |
TIME 1 hour
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Interview Prompts |
Probes and Follow-ups |
Current Work and Practices Theme
Service Improvement Theme
*Some questions adapted from Friedman, S. R., Reynolds, J., Quan, M. A., Call, S., Crusto, C. A., & Kaufman, J. S. (2007). Measuring changes in interagency collaboration: An examination of Bridgeport Safe Start Initiative. Evaluation and Program Planning 30, pp. 294-306. |
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According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays an Office of Management and Budget (OMB) control number. The valid OMB Control Number for this information collection is xxxx-xxxx. The time required to participate in the interview is estimated to average 90 minutes, including the time to review instructions, search existing data resources, gather the data needed and complete and review the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to US Department of Labor, Office of Disability Employment Policy, 200 Constitution Ave., N.W. Washington, DC 20210 and reference the OMB Control Number xxxx-xxxx.
Privacy
Act Statement
Collection and Use of Personal Information
The following statement is made in accordance with the Privacy Act of 1974 (5. U. S. C. 552a). Information collected will be handled and stored in compliance with the Freedom of Information Act and the Privacy Act of 1974, as amended (5 U.S.C. 552a). Furnishing the data requested is voluntary.
We will use the data you provide for the CAPE-Youth Research Project, funded by The United States Department of Labor, Office of Disability Employment Policy. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data.
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Matthew C Saleh |
File Modified | 0000-00-00 |
File Created | 2021-04-30 |