Information Collection

The Home-Based Child Care Toolkit for Nurturing School-Age Children Pilot Study

IC 257382 under ICR 202105-0970-011 · OMB 0970-0355.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Instrument 1. Phase one provider telephone script and recruitment information collection_clean_12-2-22 .docx Other-Interview Script
Instrument 2. Phase two provider telephone script and recruitment information collection_clean_12-2-22 .docx Other-Interview Script
Instrument 3. HBCC-NSAC Toolkit Provider Questionnaire_English_clean_12-7-22.docx Other-Questionnaire
Instrument 4. HBCC-NSAC Toolkit Family Questionnaire_clean_12-2-22.docx Other-Questionnaire
Instrument 5. Phase one provider cognitive interview guide_clean_12-2-22.docx Other-Interview Guide
Instrument 6. Phase one family cognitive interview guide_clean_12-2-22.docx Other-Interview Guide
Instrument 7. Family data collection logistics call_clean_12-2-22.docx Other-Logistical Interview
Appendix A Community organization outreach materials_clean_12-2-22.docx
Appendix A: Community organization outreach materials
IC Document
Appendix A Community organization outreach materials_Spanish_12-2-22.docx
Appendix A: Community organization outreach materials Spanish
IC Document
Appendix B Phase one provider and family recruitment materials_clean_12-2-22.docx
Appendix B: Phase one provider and family recruitment materials
IC Document
Appendix B Phase one provider and family recruitment materials_Spanish_12-2-22.docx
Appendix B: Phase one provider and family recruitment materials Spanish
IC Document
Appendix C Phase two provider and family recruitment materials_clean_12-2-22.docx
Appendix C: Phase two provider and family recruitment materials
IC Document
Appendix C Phase two provider and family recruitment materials_Spanish_12-2-22.docx
Appendix C: Phase two provider and family recruitment materials Spanish
IC Document
Appendix D Supplemental provider and family recruitment materials_clean_12-2-22.docx
Appendix D: Supplemental provider and family recruitment materials
IC Document
Appendix D Supplemental provider and family recruitment materials_Spanish_12-2-22.docx
Appendix D: Supplemental provider and family recruitment materials Spanish
IC Document
Appendix E HBCC-NSAC Toolkit provider questionnaire matrix sampling_clean_12-2-22.docx
Appendix E: HBCC-NSAC Toolkit provider questionnaire matrix sampling
IC Document
Appendix F Consent_clean_12-2-22.docx
Appendix F: Consent
IC Document
Appendix F Consent_Spanish_12-2-22.docx
Appendix F: Consent Spanish
IC Document
Appendix G Sources for HBCC-NSAC Toolkit development_clean_12-2-22.docx
Appendix G: Sources for HBCC-NSAC Toolkit development
IC Document
Appendix H HBCC-NSAC Toolkit English version pre-test summary_clean_12-2-22.docx
Appendix H: HBCC-NSAC Toolkit English version pre-test summary
IC Document
Appendix I Provider and family invitations_clean_12-2-22.docx
Appendix I: Provider and family invitations
IC Document
Appendix I Provider and family invitations_Spanish_12-2-22.docx
Appendix I: Provider and family invitations Spanish
IC Document
Appendix J Family data collection instructions_clean_12-2-22.docx
Appendix J: Family data collection instructions
IC Document
Appendix J Family data collection instructions_Spanish_12-2-22.docx
Appendix J: Family data collection instructions Spanish
IC Document
Appendix K Frequently asked questions_clean_12-2-22.docx
Appendix K: Frequently asked questions
IC Document
Appendix K Frequently asked questions_Spanish_12-2-22.docx
Appendix K: Frequently asked questions Spanish
IC Document
Appendix L Provider and family thank you letters_clean_12-2-22.docx
Appendix L: Provider and family thank you letters
IC Document
Appendix L Provider and family thank you letters_Spanish_12-2-22.docx
Appendix L: Provider and family thank you letters Spanish
IC Document
HBCCSQ CLIN 7 HBCC-NSAC Toolkit Pilot Study_SSA_clean_12-13-22.docx
Home-Based Child Care Toolkit for Nurturing School-Age Children Pilot Study SSA
IC Document
HBCCSQ CLIN 7 HBCC-NSAC Toolkit Pilot Study_SSB_clean_12-2-22.docx
Home-Based Child Care Toolkit for Nurturing School-Age Children Pilot Study SSB
IC Document
Instrument 1. Phase one provider telephone script and recruitment information collection_Spanish_12-2-22.docx
Instrument 1: Phase one provider telephone script and recruitment information collection Spanish
IC Document
Instrument 2. Phase two provider telephone script and recruitment information collection_Spanish_12-2-22.docx
Instrument 2: Phase two provider telephone script and recruitment information collection Spanish
IC Document
Instrument 3. HBCC-NSAC Toolkit Provider Questionnaire_Spanish_clean_12-7-22.docx
Instrument 3: HBCC-NSAC Toolkit provider questionnaire Spanish
IC Document
Instrument 4. HBCC-NSAC Toolkit Family Questionnaire_Spanish_clean_12-2-22.docx
Instrument 4: HBCC-NSAC Toolkit family questionnaire Spanish
IC Document
Instrument 5. Phase one provider cognitive interview guide_Spanish_12-2-22.docx
Instrument 5: Phase one provider cognitive interview guide Spanish
IC Document
Instrument 6. Phase one family cognitive interview guide_Spanish_12-2-22.docx
Instrument 6: Phase one family cognitive interview guide Spanish
IC Document
Instrument 7. Family data collection logistics call_Spanish_12-2-22.docx
Instrument 7: Family data collection logistics call Spanish
IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Interview Script Yes Yes Fillable Printable
Other-Interview Script Yes Yes Fillable Printable
Other-Questionnaire Yes Yes Fillable Printable
Other-Questionnaire Yes Yes Paper Only
Other-Interview Guide Yes Yes Fillable Fileable
Other-Interview Guide Yes Yes Fillable Fileable
Other-Logistical Interview Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 990 0 990 0 0 0
Annual IC Time Burden (Hours) 323 0 323 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Appendix A: Community organization outreach materials 12/14/2022
Appendix A: Community organization outreach materials Spanish 12/14/2022
Appendix B: Phase one provider and family recruitment materials 12/14/2022
Appendix B: Phase one provider and family recruitment materials Spanish 12/14/2022
Appendix C: Phase two provider and family recruitment materials 12/14/2022
Appendix C: Phase two provider and family recruitment materials Spanish 12/14/2022
Appendix D: Supplemental provider and family recruitment materials 12/14/2022
Appendix D: Supplemental provider and family recruitment materials Spanish 12/14/2022
Appendix E: HBCC-NSAC Toolkit provider questionnaire matrix sampling 12/14/2022
Appendix F: Consent 12/14/2022
Appendix F: Consent Spanish 12/14/2022
Appendix G: Sources for HBCC-NSAC Toolkit development 12/14/2022
Appendix H: HBCC-NSAC Toolkit English version pre-test summary 12/14/2022
Appendix I: Provider and family invitations 12/14/2022
Appendix I: Provider and family invitations Spanish 12/14/2022
Appendix J: Family data collection instructions 12/14/2022
Appendix J: Family data collection instructions Spanish 12/14/2022
Appendix K: Frequently asked questions 12/14/2022
Appendix K: Frequently asked questions Spanish 12/14/2022
Appendix L: Provider and family thank you letters 12/14/2022
Appendix L: Provider and family thank you letters Spanish 12/14/2022
Home-Based Child Care Toolkit for Nurturing School-Age Children Pilot Study SSA 12/14/2022
Home-Based Child Care Toolkit for Nurturing School-Age Children Pilot Study SSB 12/14/2022
Instrument 1: Phase one provider telephone script and recruitment information collection Spanish 12/14/2022
Instrument 2: Phase two provider telephone script and recruitment information collection Spanish 12/14/2022
Instrument 3: HBCC-NSAC Toolkit provider questionnaire Spanish 12/14/2022
Instrument 4: HBCC-NSAC Toolkit family questionnaire Spanish 12/14/2022
Instrument 5: Phase one provider cognitive interview guide Spanish 12/14/2022
Instrument 6: Phase one family cognitive interview guide Spanish 12/14/2022
Instrument 7: Family data collection logistics call Spanish 12/14/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].