Instrument 2: Study MIS to track receipt of services

Procedural Justice-Informed Alternatives to Contempt Demonstration (PJAC)

Instrument 2_ Study MIS to Track Receipt of Services_20200206

Instrument 2: Study MIS to track receipt of services

OMB: 0970-0505

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OMB #: 0970-0505

EXPIRATION DATE: XX/XX/XXXX

INFORMATION COLLECTION ACTIVITY #2

Procedural Justice informed alternatives to contempt (pjac)

Study MIS to Track Receipt of Services



Contacts/outreach



All contact attempts/contacts and dates



Was contact with custodial parent, noncustodial parent, or other?



Purpose/intent of contact



Result of contact


Enhanced investigation/locating



Social media search conducted and dates



Administrative database search conducted and dates



Paid locate services used and dates



Other investigation approaches pursued and dates


Case Management



Assessment of barriers conducted and date



Dispute resolution conducted and date



Case errors corrected and date



Ability to pay determination conducted and date



Case action plan determination and date



DV screening conducted and date



Case conference attendance and dates (CP and NCP)



Case conference outcome



Case review and date


Enhanced child support services



Administrative license reinstatement and date



Suppression of enforcement actions and date



Type of enforcement actions suppressed



Order reviewed and date



Cash payment agreement established and date



Non-cash payment agreement established and date



Arrears compromise and date



Arrears adjustment and date



Compromised/adjusted arrears owed to state, CP, or both?


Supportive services and participation



Referrals to services and dates



Type of referral



Participation in referral services and dates



Transportation support amount and date



Other support service provided (please specify) and date







































The purpose of this information collection is to assess the feasibility and efficacy of incorporating principles of procedural justice into child support services as a cost-effective alternative to civil contempt proceedings. Public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The control number is 0970-0505 and it expires on XX/XX/XXXX. If you have comments regarding this collection of information, including suggestions for reducing this burden, please send them to Cindy Redcross, 200 Vesey Street 23rd Floor New York, NY 10281; Attn: OMB-PRA (0970-0505).

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleStaff Interviews for Sites Testing CBE
AuthorEmily Brennan
File Modified0000-00-00
File Created2022-02-25

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