PMFO Feedback Surveys - Initial NOA Oct 2019

NOTICE OF OFFICE OF MANAGEMENT AND BUDGET ACTION
Date

10/05/2019

Department of Health and Human Services
Administration for Children and Families
FOR CERTIFYING OFFICIAL:

Edwin Simcox

FOR CLEARANCE OFFICER:

Debbie Kramer

In accordance with the Paperwork Reduction Act, OMB has taken action on your request received
09/27/2019
ACTION REQUESTED: Generic IC
Program Management and Fiscal Operations (PMFO) Feedback Surveys
IC TITLE:
ICR REFERENCE NUMBER:

201801-0970-013

AGENCY ICR TRACKING NUMBER:
TITLE:

OPRE

Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery

LIST OF INFORMATION COLLECTIONS: See next page
OMB ACTION: Approved without change
OMB CONTROL NUMBER:

0970-0401

The agency is required to display the OMB Control Number and inform respondents of its legal significance in
accordance with 5 CFR 1320.5(b).
EXPIRATION DATE: 05/31/2021

BURDEN:

DISCONTINUE DATE:

RESPONSES

HOURS

COSTS

Previous

44,124

17,062

0

New

44,124

17,062

0

Change due to New Statute

0

0

0

Change due to Agency Discretion

0

0

0

Change due to Agency Adjustment

0

0

0

Change due to PRA Violation

0

0

0

Difference

TERMS OF CLEARANCE:

Terms of the Generic ICR remain in effect.

OMB Authorizing Official:

Paul Ray
Administrator,
Office Of Information And Regulatory Affairs

IC Title

Form No.

Child Welfare
1
Information Gateway's
Customer Satisfaction
Assessment
Comment Form:
FRPN Feedback
Fatherhood Research Instrument
and Practice Netrwork
Learning Community
Focus Group with
1
Healthy Marriage and
Relationship Education
(HMRE)
Maternal, Infant, and
1
Early Childhood Home
Visiting (MIECHV) TA
Satisfaction Survey
Maternal, Infant, and
1
Early Childhood Home
Visiting (MEICHV)
Continuous Quality
Improvement
Regorous Evaluation
1
Technical Assistance
(RETA) Feedback Form
ACF Office of Regional 1
Operations Curstomers
Feedback for Learning
Experiences
nFORM Help Desk
Customer Service
Feedback Surveys
CCDF Administrator
1
Feedback Collection
Communities of
1
Practice
ECTTAS Coordination 1
Survey
Infant Toddler Spcialist 1
Infividualized Technical
Assistance
Infant Toddler Specialist 1
Presentation
Feedback Colection for 1
Peer Leaning
OHS TTA Network
1
Training Feedback
Form
Region XII Migrant and 1
Seasonal Head Start
T/TA Service Deloivery
Feedback
Comment Form: 2018
OPRE Innovative
Methods Meeting.
ANA Youth Summit
1
Survey
OFA TANF TA
1
Convening Individual
Session Assessment
OFA TANF TA
1
Convening Overall
Evaluation Assessment
Information Architecture 1
Testing of the Early
Childhood Learning and
Knowledge Center

List of ICs
Form Name

CFR Citation

Hrs/$/Resp

CWIG Customer
Satisfaction Assessment
Data Collection
Instruments
FRPN Feedback
Instrument

423 / 0 / 8,150

SARHM generic OMB

53 / 0 / 40

DOHVE 2

25 / 0 / 150

MIECHV

22 / 0 / 65

RETA-Feedback Form

42 / 0 / 126

ORO Webinar or Meeting
Feedback Survey

1,588 / 0 / 7,100

3 / 0 / 40

57 / 0 / 688
CCDF Administrators

11 / 0 / 65

Communities of Practice

8 / 0 / 60

ECTTAS Coordination
Survey
Infant Toddler Specialist
Individualized Technical
Assistance
Infant Toddler Specialist
Presentations
Peer Learning

6 / 0 / 60

TTA Network Training
Feedback

100 / 0 / 1,200

Service Delivery
Feedback Form OHS
Region 12

10 / 0 / 40

1/0/9
18 / 0 / 135
13 / 0 / 100

8 / 0 / 100
2018 I-LEAD Youth
Summiot Survey
OFA Convening Individual
Assessment

33 / 0 / 100

OFA Convening Overall
Assessment

33 / 0 / 400

ECLKC-tree-jack survey
instrument

16 / 0 / 192

29 / 0 / 350

IC Title

Form No.

Infant Toddler Specialist 1
Network Training for
Trainers (TFT)
TA Assistance
1
Feedback Collection for
Webinars
HSICC Post Phone Call 1
Survey
2018 ANA Grantee
1
Meeting Pre-Survey
Maternal, Infant, and
Early Childhood Home
Visiting (MIECHV) AGM
2019 – Peer Sharing
Feedback Survey
2019 Youth Summit
1
Committe Planning
Survey
State Capacity Building 1
Center Tailored TA
Feedback Collection for
Impact Project
Audience Research for 1, 1, 1
Sexual Risk Avoidance
(SRA) Social Media
Marketing Campaign
Sexual Risk Avoidance 1, 1, 1, 1, 1
(SRA) Social Media
Marketing Campaign

Region XII MSHS T/TA 1
Network Technical
Assistance Services
Delivery Feedback
Course Participant
36, 1, 1, 1, 1, 1, 1, 1, 1,
Knowledge Gain
1, 1, 1, 1, 1, 1
Assessment and
Instructior and Course
Participant
Experimental Feedback

Maternal, Infant, and
Early Childhood Home
Visiting (MIECHV) AGM
2019 – Peer Sharing
Feedback Survey
Input on Key Functions
of Early Care and
Education Research
Connections Website
Adolescent Pregnancy 1
Preventing Training &
Technical Assistance

List of ICs
Form Name

CFR Citation

Hrs/$/Resp

Traininging for Training

35 / 0 / 180

Task 3 Webinars

25 / 0 / 300

Post Phone Calll Survey

15 / 0 / 300

Grantee Meeting PreSurvey

47 / 0 / 188
29 / 0 / 350

ILIAD 2019 Youth Summit
Planning Committee
Survey
OCC OMB SCBC Task 4
Impact Instrument

7 / 0 / 26

CTK Parent Consent
Form, Attachment 1, CTK
Youth Assent Form

150 / 0 / 100

Display, CTK Youth
Assent Form, CTK Parent
Consent Form,
Attachment 1 Discussion
Prompts, Youth Assent
Form The Hive
Region-XII-TTA Feedback
Form

70 / 0 / 280

EBPAS-36, Instructior
Experience Survey Final,
Instructor Unit Survey
Final, Participant
Experience Survey Final,
Unit 1 Post Test Final,
Unit 2 Post-Test Final,
Unit 2 Pre-Test Final, Unit
3 Post-Test Final, Unit 3
Pre-Test Final, Unit 4
Post-Test Final, Unit 4
Pre--Test Final, Unit 5
Post-Test Final, Unit 5
Pre-Test Final, Unit 6
Post-Test Final, Unit 6
Pre-Test Final

145 / 0 / 145

5 / 0 / 18

50 / 0 / 300

29 / 0 / 350

21 / 0 / 250

Attachment 1-Survey

33 / 0 / 100

IC Title

Form No.

Feedback on Strategies 1
Related to Opioid
Misuse
Sexual Risk Avoidance 1
(SRA) Social Media
Marketing Campaign
2018 ANA Grantee
1
Meeting Survey
Feedback on Webinars
for Data Use and
General Info for the
National Survey of Early
Care and Education
(NSECE)
Child Welfare Program 1, 1, 1, 1
Improvement Plan Pilot
Evaluation
Center for States
Subscription Form
Listening Session
Questions on OHS
Training and Technical
Assistance System
Feedback Survey for
Technical and Training
Assistance Activities for
Family and Youth
Services Bureau/
Runaway and
Homeless Youth
grantees
Child Welfare
Information Gateway
Subscription Form
Usability testing for the
"Pathways to Work
Evidence
Clearinghouse" website
Sexual Risk Avoidance
Education (SRAE)
Grantee Training and
Technical Assistance
Satisfaction Survey
Feedback from Child
Care and Early
Education Policy
Research Consortium
(CCEEPRC) Members
on the CCEEPRC 2019
Annual Meeting
Child Care
Development Block
Grant (CCDBG)
Implementation
Research and
Evaluation Grantees Meeting Evaluation
Form
Feedback on MixedDelivery System and
Service Coordination to
Inform Appropriate,
Tailored and Timely
Technical Assistance

List of ICs
Form Name

CFR Citation

Hrs/$/Resp

Feedback Form on
Strategies Related to
Opioid Misuse
Social Norms Quiz

131 / 0 / 1,574

ANA GM - Blank Survey
Form

47 / 0 / 940

33 / 0 / 400

32 / 0 / 600

PIPPilot
PreonsiteFeedbackSurvey
, PIPPilot, PIPPilot,
PIPPilot Onsite Feedback
Survey

154 / 0 / 336

61 / 0 / 1,223
20 / 0 / 80

13 / 0 / 80

1,244 / 0 / 24,888
29 / 0 / 29

45 / 0 / 108

27 / 0 / 200

2 / 0 / 27

4 / 0 / 46

IC Title
Adolescent Pregnancy
Prevention Training &
Technical Assistance
2019 Conference
Feedback Surveys
Runaway and
Homeless Youth (RHY)
Regional Meeting
Evaluation
Administration for
Native Americans
(ANA) Post Peer Panel
Review Survey
Administration for
Native Americans
(ANA) Application
Submission Process
Feedback Survey
2019 Low Income
Home Energy
Assistance Program
(LIHEAP) Grantee
Conference Feedback
Evaluation of Family
Violence Prevention
and Services Act
(FVPSA) Regional
Meeting
2019 Reader Feedback:
Brush Up on Oral
Health
FY2019 New Capacity
Building Center for
States Community of
Practice: County
Administered State
Support Interest Survey
Children's Bureau
Grantee Feedback
Survey
National Center on
Early Childhood Health
and Wellness
(NCECHW) Infoline
Feedback Form
Family Violence
Prevention and
Services (FVPSA) 2019
Tribal Grantee Meeting
Community Economic
Development (CED) or
Rural Community
Development (RCD)
Grantee Discussion
Groups
Community Economic
Development (CED)
Grantee Training Needs
Assessment
Personal Responsibility
Education Program
(PREP) Grantee
Training and Technical
Assistance Satisfaction
and Needs Assessment

Form No.

List of ICs
Form Name

CFR Citation

Hrs/$/Resp
201 / 0 / 1,925

38 / 0 / 450

17 / 0 / 100

50 / 0 / 300

15 / 0 / 150

63 / 0 / 250

27 / 0 / 325
4 / 0 / 45

12 / 0 / 140
30 / 0 / 360

21 / 0 / 253

90 / 0 / 90

41 / 0 / 164

35 / 0 / 85

IC Title

Form No.

List of ICs
Form Name

CFR Citation

Children's Bureau
Grantee Connection
Survey
2019 National Runaway
and Homeless Youth
(RHY) Grantees
Training Evaluations
Child Care
Development Block
Grant (CCDBG)
Implementation
Research Webinar
Feedback Poll
Program Management
and Fiscal Operations
(PMFO) Feedback
Surveys
Total Hours Actually Used for Information Collections Under Currently Approved ICR:

Hrs/$/Resp
9 / 0 / 112
93 / 0 / 1,750

7 / 0 / 200

196 / 0 / 1,875

5,951