Public Access to Diaper Information

Formative Data Collections for ACF Program Support

Attachment A Diaper Access Survey

Public Access to Diaper Information

OMB: 0970-0531

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Diaper	Access	Survey	for	Grant	Recipients
In	order	to	enhance	the	public's	ability	to	access	diapers	through	DDDRP,	OCS	is
creating	documents	with	information	about	how	to	receive	free	diapers.	These
documents	will	be	posted	on	the	DDDRP	website
(www.acf.hhs.gov/ocs/programs/diaper-distribution-pilot).	In	this	form,	please
provide	any	information	that	your	organization	would	like	to	be	available	to	the
general	public.	OCS	aims	to	provide	easy-to-understand	information	about	when,
where,	and	how	families	can	receive	diapers	for	their	children.
This	is	a	voluntary	collection	of	information.	It	should	take	you	about	30	minutes	to
complete	this	survey.	The	information	shared	will	be	made	public.	
	
PAPERWORK	REDUCTION	ACT	OF	1995	(Pub.	L.	104-13)	STATEMENT	OF	PUBLIC
BURDEN:	The	purpose	of	this	information	collection	is	to	help	the	federal	program
team	understand	how	the	public	can	access	diapers	through	DDDRP.	Public
reporting	burden	for	this	collection	of	information	is	estimated	to	average	30
minutes	per	respondent,	including	the	time	for	reviewing	instructions,	gathering
and	maintaining	the	data	needed,	and	reviewing	the	collection	of	information.	This
is	a	voluntary	collection	of	information.	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	0970-0531	and	the	expiration	date	is
9/30/2025.	If	you	have	any	comments	on	this	collection	of	information,	please
contact	Juliana	Melara	at	[email protected].

Diaper	Access	Survey	for	Grant	Recipients
1.	What	is	the	name	of	your	organization?	

2.	What	other	partner	organizations	do	you	work	with	to	distribute	diapers?	

3.	How	would	a	family	receive	diapers	from	you?
If	families	must	pick	up	their	diapers,	please	provide	the	list	of	pick-up	locations.	
If	you	deliver	diapers	directly	to	families,	please	provide	the	areas	where	you	deliver.
If	your	program	operates	differently,	please	provide	details.	

4.	Please	describe	any	geographic	eligibility	criteria	(e.g.,	resident	of	a	certain	geographic
area).	If	this	varies	by	partner	organization,	please	list	the	eligibility	for	each	partner.	

5.	Please	describe	income	eligibility	criteria	(e.g.,	must	have	an	income	below	a	certain	level).
If	this	varies	by	partner	organization,	please	list	the	eligibility	for	each	partner.	

6.	Please	describe	any	eligibility	criteria	related	to	participation	in	other	programs	(e.g.,	must
be	enrolled	in	another	program,	like	Head	Start	or	WIC).	If	this	varies	by	partner
organization,	please	list	the	eligibility	for	each	partner.	

7.	Please	describe	any	other	eligibility	criteria.	If	this	varies	by	partner	organization,	please
list	the	eligibility	for	each	partner.	

8.	If	you	distribute	on	certain	days	or	times,	please	provide	a	list	of	those	dates	(or	a	link
where	clients	can	see	upcoming	distribution	dates).	If	you	distribute	by	appointment,	please
provide	information	about	how	to	schedule	an	appointment.	

9.	If	families	need	to	enroll	in	advance,	please	provide	information	about	how	to	do	so	(for
example,	a	phone	number	or	online	link	to	registration	form).		

10.	If	families	need	to	bring	particular	materials	in	order	to	pick	up	diapers	(for	example,
birth	certificate	or	proof	of	income),	please	provide	that	list	here.	

11.	If	families	would	like	to	talk	to	someone	to	better	understand	your	program,	who	is	the
correct	contact	person	and	what	is	their	contact	information?	

12.	If	you	have	a	website,	social	media,	or	flyer	that	you	would	like	linked	to	this	document,
please	provide	that	link.	


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