Multi-Site Study of State-Tribal Collaboration in Home Visiting

Formative Data Collections for ACF Program Support

OMB: 0970-0531

IC ID: 254587

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0531 can be found here:

2024-03-05 - No material or nonsubstantive change to a currently approved collection
2024-01-25 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
Instrument A - MUSE-STC Interview Protocol_OMB_clean_fnl.docx Other-Interview Protocol
Instrument A - MUSE-STC Interview Protocol_OMB_clean_fnl.docx Other-Interview Protocol
Generics Supporting Statement A - MUSE-STC_OMB_clean_OMB_ACF_clean.docx SSA Prog Supp GenIC - Multi-Site Study of State-Tribal Collaboration in Home Visiting IC Document
Generics Supporting Statement A - MUSE-STC_OMB_clean_OMB_ACF_clean.docx SSA Prog Supp GenIC - Multi-Site Study of State-Tribal Collaboration in Home Visiting IC Document
Generics Supporting Statement B - MUSE-STC_OMB_clean.docx SSB Prog Supp GenIC - Multi-Site Study of State-Tribal Collaboration in Home Visiting IC Document
Generics Supporting Statement B - MUSE-STC_OMB_clean.docx SSB Prog Supp GenIC - Multi-Site Study of State-Tribal Collaboration in Home Visiting IC Document
Appendix A - MUSE-STC Draft Interview Recruitment Email and Phone Script_OMB.docx APPENDIX A: Draft Recruitment Email and Call Script IC Document
Appendix A - MUSE-STC Draft Interview Recruitment Email and Phone Script_OMB.docx APPENDIX A: Draft Recruitment Email and Call Script IC Document
Appendix B -Study Notification Email from Health Resources and Services Administration_OMB_clean.docx APPENDIX B: Draft Study Notification Email from Health Resources and Services Administration IC Document
Appendix B -Study Notification Email from Health Resources and Services Administration_OMB_clean.docx APPENDIX B: Draft Study Notification Email from Health Resources and Services Administration IC Document
Appendix C - MUSE-STC Site Engagement Email_OMB.docx APPENDIX C: MUSE-STC Site Engagement Email IC Document
Appendix C - MUSE-STC Site Engagement Email_OMB.docx APPENDIX C: MUSE-STC Site Engagement Email IC Document
Appendix D - MUSE-STC research flyer_OMB_clean.docx APPENDIX D: MUSE-STC Research Flyer IC Document
Appendix D - MUSE-STC research flyer_OMB_clean.docx APPENDIX D: MUSE-STC Research Flyer IC Document
Appendix E - MUSE-STC Consent Form_OMB_clean.docx APPENDIX E: MUSE-STC Consent Form IC Document
Appendix E - MUSE-STC Consent Form_OMB_clean.docx APPENDIX E: MUSE-STC Consent Form IC Document
NOA_MUSE Formative GenIC Prog Supp_0970-0531_6.22.22.pdf NOA_MUSE Formative GenIC Prog Supp IC Document
NOA_MUSE Formative GenIC Prog Supp_0970-0531_6.22.22.pdf NOA_MUSE Formative GenIC Prog Supp IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Multi-Site Study of State-Tribal Collaboration in Home Visiting	Agency IC Tracking Number:	OPRE

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview Protocol			Instrument A - MUSE-STC Interview Protocol_OMB_clean_fnl.docx		Yes	Yes	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 42	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	42	42
Annual IC Time Burden (Hours)	63	63
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA Prog Supp GenIC - Multi-Site Study of State-Tribal Collaboration in Home Visiting	Generics Supporting Statement A - MUSE-STC_OMB_clean_OMB_ACF_clean.docx	07/11/2022
SSB Prog Supp GenIC - Multi-Site Study of State-Tribal Collaboration in Home Visiting	Generics Supporting Statement B - MUSE-STC_OMB_clean.docx	07/11/2022
APPENDIX A: Draft Recruitment Email and Call Script	Appendix A - MUSE-STC Draft Interview Recruitment Email and Phone Script_OMB.docx	07/11/2022
APPENDIX B: Draft Study Notification Email from Health Resources and Services Administration	Appendix B -Study Notification Email from Health Resources and Services Administration_OMB_clean.docx	07/11/2022
APPENDIX C: MUSE-STC Site Engagement Email	Appendix C - MUSE-STC Site Engagement Email_OMB.docx	07/11/2022
APPENDIX D: MUSE-STC Research Flyer	Appendix D - MUSE-STC research flyer_OMB_clean.docx	07/11/2022
APPENDIX E: MUSE-STC Consent Form	Appendix E - MUSE-STC Consent Form_OMB_clean.docx	07/11/2022
NOA_MUSE Formative GenIC Prog Supp	NOA_MUSE Formative GenIC Prog Supp_0970-0531_6.22.22.pdf	07/11/2022

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