Information Collection Request

Center for States Evaluation Ancillary Data Collection

ICR 202306-0970-013 · OMB 0970-0501 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Annual Assessment Update (8 systematic questions) Form and Instruction Removed Repair queued
SSB - CfS Eval Ancillary IC_fnl 6.26.23.docx Supporting Statement B Uploaded 2023-07-14 Available
SSA - CfS Eval Ancillary IC_fnl 6.28.23.docx Supporting Statement A Uploaded 2023-07-14 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
261096 Peer Group Focus Group Protocol Other-Focus Group Protocol New
261095 Outcomes of and Satisfaction with Tailored Services Survey Appended Items (Section 4) Other-Survey New
261094 Jurisdiction Lead Survey Related to Lived Experience Other-Survey New
261093 Jurisdiction Lead Observation Debrief Protocol Other-Debrief Protocol New
261092 Jurisdiction Lead Interview Other-Interview New
226795 Annual Assessment Update (8 systematic questions) Form and Instruction Removed
226794 Assessment and Service Delivery State Lead Interviews-Supplemental Questions Other-Supplemental Questions Removed
226793 Service Delivery and Tracking and Adjustment Observation-Group Debrief Other-Group Debrief Removed
226792 Assessment Observation-Group Debrief Other-Group Debrief Removed
226791 Tailored Services Practice Model Survey Other-Model Survey Removed
226790 Child Welfare Virtual Conference Exit Survey Other-Exit Survey Modified
226788 Child Welfare Virtual Conference Registration Form Other-Registration Form Modified
226787 Child Welfare Virtual Conference Interview Guide Other-Virtual Interview Guide Removed
226786 Child Welfare Virtual Conference Focus Group Guide Other-Focus Group Guide Removed
226785 Child Welfare Virtual Conference Session Surveys Other-Session Surveys Removed

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 09/30/2023
3,585 4,319
381 390
0 0





table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 3,585 4,319 0 -2,809 2,075 0
Annual Time Burden (Hours) 381 390 0 -118 109 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No