NOA for previous approval of Standard Feedback Survey for the NCHBHS TTA Offerings

NOTICE OF OFFICE OF MANAGEMENT AND BUDGET ACTION
Date

02/12/2021

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

Perryn Ashmore

FOR CLEARANCE OFFICER:

Terry Clark

In accordance with the Paperwork Reduction Act, OMB has taken action on your request received
02/12/2021
ACTION REQUESTED: Generic IC
Standard Feedback Survey for the National Center for Health, Behavioral Health, and Safety's
IC TITLE:
Training and Technical Assistance Offerings
ICR REFERENCE NUMBER:
202007-0970-006
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:

Dominic J. Mancini
Deputy and Acting 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
Feedback on Strategies 1
Related to Opioid
Misuse

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

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

70 / 0 / 280

EBPAS-36, Unit 6 PreTest 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, Instructior
Experience Survey Final

145 / 0 / 145

5 / 0 / 18

50 / 0 / 300

29 / 0 / 350

21 / 0 / 250

Attachment 1-Survey

33 / 0 / 100

Feedback Form on
Strategies Related to
Opioid Misuse

131 / 0 / 1,574

IC Title

Form No.

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

Social Norms Quiz

33 / 0 / 400

ANA GM - Blank Survey
Form

47 / 0 / 940
32 / 0 / 600

PIPPilot Onsite Feedback
Survey, PIPPilot, PIPPilot
PreonsiteFeedbackSurvey
, PIPPilot

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
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
Child Welfare Capacity
Building Collaborative
Customer Feedback for
Webinars and Events
Program Management
and Fiscal Operations
(PMFO) Feedback
Surveys
Comment Form: 2019
OPRE Innovative
Methods Meeting.
Program Management
and Fiscal Operations
(PMFO) Feedback
Survey about the
General Business
Studies Certificate.
Program Management
and Fiscal Operations
(PMFO) Consulting
Initiative (FCI)
Feedback Surveys
Family Violence
Prevention and
Services (FVPSA) 2020
Tribal Grantee Meeting
Coaching Companion
Questionnaire
Tribal Home Visiting
Technical Assistance
Evaluation Feedback
and Immediate
Feedback Forms
Maternal, Infant, and
Early Childhood Home
Visiting All Grantee &
Tribal Regional
Meetings Feedback
Tools
In-Person Convening
Child Care Policy
Research Partnership Participant Feedback
Child Care and
Development Fund
(CCDF) Policies
Database Pop-Up
Survey of Website
Users
Leadership Initiative
Feedback Surveys

Form No.

List of ICs
Form Name

CFR Citation

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

7 / 0 / 200

27 / 0 / 53

196 / 0 / 1,875

21 / 0 / 125
3 / 0 / 16

15 / 0 / 180

5 / 0 / 65

41 / 0 / 350
17 / 0 / 115

145 / 0 / 1,450

5 / 0 / 28

25 / 0 / 500

14 / 0 / 70

IC Title
Feedback on National
Center on Parent,
Family and Community
Engagement (NCPFCE)
Resources
New Director Mentor
Program (NDMP)
Feedback Surveys
Building Evidence
Training (BET) Project
Usability Testing
Feedback Survey for
Human Trafficking
webinars, online
training, online sessions
hosted by the Family
and Youth Services
Bureau
Grantee Exchange
Platform Survey
Child Care
Development Block
Grant (CCDBG)
National Webinar
Feedback Poll
National Youth in
Transition Database
(NYTD) Technical
Assistance Utilization
and Needs Survey
Feedback from Child
Care and Early
Education Policy
Research Consortium
(CCEEPRC) Members
on the CCEEPRC 2020
Annual Meeting
Feedback Survey for
capacity building,
grantee, training, online
sessions hosted by the
Family and Youth
Services Bureau
2020 ACF Native
American Grantee
Meeting Survey
Public Assistance
Reporting Information
System (PARIS)
Training Conference
Post Event Survey
Runaway and
Homeless Youth (RHY)
Regional Meeting
Evaluation
Grant Review Panel
Chair Development
Training
Sexual Risk Avoidance
Education (SRAE)
Grantee Webinar
Satisfaction Survey
Head Start
Management Fellows
(HSMF) Program
Feedback Surveys

Form No.

List of ICs
Form Name

CFR Citation

Hrs/$/Resp
75 / 0 / 450

21 / 0 / 63
98 / 0 / 43
83 / 0 / 500

4 / 0 / 52
2 / 0 / 100

24 / 0 / 291

25 / 0 / 150

83 / 0 / 500

67 / 0 / 400
20 / 0 / 240

108 / 0 / 1,300

3 / 0 / 30
83 / 0 / 200

53 / 0 / 270

IC Title
2020 ACF Tribal Peerto-Peer Grantee
Meeting Survey
Feedback on Child Care
and Development Fund
Plan for
States/Territories for
FFY 2019–2021
(ACF–118)
Child Welfare
Information Gateway
Needs Assessment
Focus Group Guide
Center for States Needs
Assessment Focus
Group
Center for States 2020
Needs Assessment
Survey
ACF State and County
Human Services
Commissioner Surveys
Program Management
and Fiscal Operations
(PMFO) Hurricane
Response and
Recovery (HRR)
Feedback Survey.
Child Care and
Development Block
Grant (CCDBG)
Implementation
Research and
Evaluation Grantees Meeting Evaluation
Form
In-Person Convening
Child Care Policy
Research Partnership –
Participant Feedback
Grantee Feedback for
the FVPSA Formula
Grantee Meeting
Planning
Child Welfare
Information Gateway
Prevention Resource
Guide Tip Sheet
Feedback Form
Sexual Risk Avoidance
Education (SRAE)
Grantee Needs
Assessment
Office of Refugee
Resettlement (ORR)
Refugee Programs
Training and Technical
Assistance Evaluation
Adolescent Pregnancy
Prevention Training &
Technical Assistance
2020 Conference
Feedback Surveys

Form No.

List of ICs
Form Name

CFR Citation

Hrs/$/Resp
21 / 0 / 250
84 / 0 / 56

48 / 0 / 32

30 / 0 / 30
33 / 0 / 200
63 / 0 / 125
4 / 0 / 24

2 / 0 / 22

3 / 0 / 38

100 / 0 / 100

6 / 0 / 35

32 / 0 / 126

119 / 0 / 714

200 / 0 / 2,200

IC Title
Poll questions for a
National Runaway
Safeline (NRS) webinar
for grantees
National Responsible
Fatherhood
Clearinghouse User
Feedback and Content
Runaway and
Homeless Youth (RHY)
Program Virtual Town
Halls (Interactive Polling
Questions)
Administration for
Native Americans
(ANA) 2020 Initiative for
Leadership,
Empowerment and
Development (I-LEAD)
Youth Webinar Series
Surveys
Evidence-Building
Academy Participant
Project Introduction
Administration for
Native Americans
(ANA) 2020
Discretionary
Application Process and
Peer Panel Review
Surveys
Peer-Based Technical
Training and Technical
Assistance Feedback
Collection Activities
Office of Family
Assistance PeerTA
website Evaluation and
Satisfaction Survey
Evidence Building
Academy Midpoint
Evaluation Form
Virtual meeting for
soliciting feedback on
recruitment and
engagement strategies
Evidence-Building
Academy Participant
Project Update and
Data Visualizations
CCDBG Implementation
Research and
Evaluation Grantee
Community of Practice
Meeting Evaluation
Form
Family and Youth
Services Bureau
(FYSB) Grantee COVID
Survey
Administration for
Native Americans
(ANA) 2021 Grantee
Meeting Logistics
Survey

Form No.

List of ICs
Form Name

CFR Citation

Hrs/$/Resp
13 / 0 / 150

94 / 0 / 1,125

11 / 0 / 650

30 / 0 / 120

72 / 0 / 100
83 / 0 / 500

29 / 0 / 348

83 / 0 / 500

44 / 0 / 174
23 / 0 / 23

54 / 0 / 50

2 / 0 / 22

71 / 0 / 284

9 / 0 / 184

IC Title
2020 OPRE Innovative
Methods Meeting:
Comment Form
Evidence-Building
Academy Daily
Feedback Forms and
Final Evaluation Form
Center for States
Internal Evaluation:
Interviews with
Jurisdictions
Florida Prototype
Project Pilot Feedback
Human-Centered
Design (HCD) Primer
Workshop Feedback
Forms
Panelist and Chair post
review surveys for the
Family and Youth
Services Bureau
(FYSB) Discretionary
Grant Programs
Native American
Language Symposium
Survey and Sessions
Survey
Runaway and
Homeless Youth (RHY)
Monitoring Site Visit 360
Feedback Forms
Child Care Policy
Research Partnership
Community of Practice Year 1 Customer
Comments
Feedback Survey for
the NS2G Learning
Community Calls
Feedback related to
PDG B-5 TA Center
Annual All-Grantee
Convening
Office of Refugee
Resettlement
Unaccompanied Alien
Children (UAC) Path
Pre Train-the-Trainer
2021 Survey
Scale for Assessing the
Attainment of Technical
Assistance Outcomes
Feedback Related to
PDG B-5 Technical
Assistance Center
Webinars and
Workshops
Feedback related to
PDG B-5 Technical
Assistance Center
Tailored Technical
Assistance

Form No.

List of ICs
Form Name

CFR Citation

Hrs/$/Resp
63 / 0 / 250
87 / 0 / 174

30 / 0 / 30

38 / 0 / 76
4 / 0 / 42

200 / 0 / 1,200

90 / 0 / 1,800

29 / 0 / 171

5 / 0 / 40

25 / 0 / 100
23 / 0 / 750

5 / 0 / 61

3 / 0 / 35
29 / 0 / 350

3 / 0 / 35

IC Title

Form No.

List of ICs
Form Name

CFR Citation

Feedback Related to
PDG B-5 Technical
Assistance Center
Communities of
Practice and
Workgroups
Tribal Home Visiting
Evaluation Institute
(TEI) Technical
Assistance (TA)
Satisfaction Survey
Feedback on the
Provision of Technical
Assistance for Personal
Responsibility
Education Innovative
Strategies Program
(PREIS) and Tribal
PREP (TPREP)
Grantees
Feedback on the
Evaluation Goals from
the Human Trafficking
Youth Prevention
Education (HTYPE)
Demonstration Program
Sexual Risk Avoidance
Education (SRAE)
Grantee Feedback
Survey
Personal Responsibility
Education Program
(PREP) Grantee
Training and Technical
Assistance Feedback
Adolescent Pregnancy
Prevention Program
(APP) Grantee
Conference Planning
Committee Feedback
2021 Administration for
Native Americans
(ANA) Virtual Grantee
Meeting Survey
Standard Feedback
Survey for the National
Center for Health,
Behavioral Health, and
Safety's Training and
Technical Assistance
Offerings
Total Hours Actually Used for Information Collections Under Currently Approved ICR:

Hrs/$/Resp
27 / 0 / 325

8 / 0 / 23

10 / 0 / 40

7 / 0 / 40

44 / 0 / 174

36 / 0 / 85

75 / 0 / 75

127 / 0 / 3,600

5,250 / 0 / 63,000

14,599