Attachment D: GenIC Example - Monitoring Activities - Document Submission

Example Generic Information Collection for Monitoring Activities

Document Submission Chart

In the chart below, for each regulation listed, please provide the title of the document being provided for pre-visit review, its file name or URL, the page or section that addresses the specific regulation, and the date that the document is being submitted to ACF. One document may be listed for multiple regulations. ACF will review this information prior to conducting the scheduled on-site monitoring visit.

Regulations	Document to Review	File Name or URL	Page/Section	Date Sent
Topic 1 - Disaster Preparedness, Response, and Recovery
Regulation Component
Regulation Component

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, ACF is gathering information about states’ compliance with activities as required in the XX regulations. Public reporting burden for this collection of information is estimated to average 10 hours per grantee, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This collection of information is required to retain a benefit, per XX authority. 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 OMB # is 0970-0XXX and the expiration date is XX/XX/XXXX. If you have any comments on this collection of information, please contact [contact information].

Regulations	Document to Review	File Name or URL	Page/Section	Date Sent
Topic 2 - Consumer Education: Dissemination of Information to Parents, Providers, and General Public
Regulation Component
Regulation Component
Topic 3 – Twelve-Month Eligibility
Regulation Component

Regulations	Document to Review	File Name or URL	Page/Section	Date Sent
Regulation Component
Regulation Component
Topic 4 - Ratios and Group Sizes
Regulation Component
Regulation Component

Regulations	Document to Review	File Name or URL	Page/Section	Date Sent
Topic 5 - Health and Safety Requirements for Providers
Regulation Component
Regulation Component
Regulation Component
Regulation Component

Regulations	Document to Review	File Name or URL	Page/Section	Date Sent
Regulation Component

Regulations	Document to Review	File Name or URL	Page/Section	Date Sent
Topic 6 - Pre-Service/Orientation and Ongoing Training for Providers
Regulation Component
Regulation Component

Regulations	Document to Review	File Name or URL	Page/Section	Date Sent
Topic 7 - Inspections for Licensed Providers
Regulation Component
Topic 8 -Inspections for License-Exempt Providers
Regulation Component

Regulations	Document to Review	File Name or URL	Page/Section	Date Sent
Topic 9 - Program Integrity and Accountability
Regulation Component
Regulation Component
Regulation Component