Information Collection

The Home-Based Child Care Toolkit for Nurturing School-Age Children Pilot Study

IC 257382 under ICR 202403-0970-004 · OMB 0970-0355.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0355 can be found here:

2026-01-30 - No material or nonsubstantive change to a currently approved collection
2025-03-28 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 1. Phase one provider telephone script and recruitment information collection_clean_12-2-22 .docx	Other-Interview Script
Instrument 1. Phase one provider telephone script and recruitment information collection_clean_12-2-22 .docx	Other-Interview Script
Instrument 2. Phase two provider telephone script and recruitment information collection_clean_12-2-22 .docx	Other-Interview Script
Instrument 2. Phase two provider telephone script and recruitment information collection_clean_12-2-22 .docx	Other-Interview Script
Instrument 3. HBCC-NSAC Toolkit Provider Questionnaire_English_clean_12-7-22.docx	Other-Questionnaire
Instrument 3. HBCC-NSAC Toolkit Provider Questionnaire_English_clean_12-7-22.docx	Other-Questionnaire
Instrument 4. HBCC-NSAC Toolkit Family Questionnaire_clean_12-2-22.docx	Other-Questionnaire
Instrument 4. HBCC-NSAC Toolkit Family Questionnaire_clean_12-2-22.docx	Other-Questionnaire
Instrument 5. Phase one provider cognitive interview guide_clean_12-2-22.docx	Other-Interview Guide
Instrument 5. Phase one provider cognitive interview guide_clean_12-2-22.docx	Other-Interview Guide
Instrument 6. Phase one family cognitive interview guide_clean_12-2-22.docx	Other-Interview Guide
Instrument 6. Phase one family cognitive interview guide_clean_12-2-22.docx	Other-Interview Guide
Instrument 7. Family data collection logistics call_clean_12-2-22.docx	Other-Logistical Interview
Instrument 7. Family data collection logistics call_clean_12-2-22.docx	Other-Logistical Interview
Appendix A Community organization outreach materials_clean_12-2-22.docx Appendix A: Community organization outreach materials	IC Document
Appendix A Community organization outreach materials_clean_12-2-22.docx Appendix A: Community organization outreach materials	IC Document
Appendix A Community organization outreach materials_Spanish_12-2-22.docx Appendix A: Community organization outreach materials Spanish	IC Document
Appendix A Community organization outreach materials_Spanish_12-2-22.docx Appendix A: Community organization outreach materials Spanish	IC Document
Appendix B Phase one provider and family recruitment materials_clean_12-2-22.docx Appendix B: Phase one provider and family recruitment materials	IC Document
Appendix B Phase one provider and family recruitment materials_clean_12-2-22.docx Appendix B: Phase one provider and family recruitment materials	IC Document
Appendix B Phase one provider and family recruitment materials_Spanish_12-2-22.docx Appendix B: Phase one provider and family recruitment materials Spanish	IC Document
Appendix B Phase one provider and family recruitment materials_Spanish_12-2-22.docx Appendix B: Phase one provider and family recruitment materials Spanish	IC Document
Appendix C Phase two provider and family recruitment materials_clean_12-2-22.docx Appendix C: Phase two provider and family recruitment materials	IC Document
Appendix C Phase two provider and family recruitment materials_clean_12-2-22.docx Appendix C: Phase two provider and family recruitment materials	IC Document
Appendix C Phase two provider and family recruitment materials_Spanish_12-2-22.docx Appendix C: Phase two provider and family recruitment materials Spanish	IC Document
Appendix C Phase two provider and family recruitment materials_Spanish_12-2-22.docx Appendix C: Phase two provider and family recruitment materials Spanish	IC Document
Appendix D Supplemental provider and family recruitment materials_clean_12-2-22.docx Appendix D: Supplemental provider and family recruitment materials	IC Document
Appendix D Supplemental provider and family recruitment materials_clean_12-2-22.docx Appendix D: Supplemental provider and family recruitment materials	IC Document
Appendix D Supplemental provider and family recruitment materials_Spanish_12-2-22.docx Appendix D: Supplemental provider and family recruitment materials Spanish	IC Document
Appendix D Supplemental provider and family recruitment materials_Spanish_12-2-22.docx Appendix D: Supplemental provider and family recruitment materials Spanish	IC Document
Appendix E HBCC-NSAC Toolkit provider questionnaire matrix sampling_clean_12-2-22.docx Appendix E: HBCC-NSAC Toolkit provider questionnaire matrix sampling	IC Document
Appendix E HBCC-NSAC Toolkit provider questionnaire matrix sampling_clean_12-2-22.docx Appendix E: HBCC-NSAC Toolkit provider questionnaire matrix sampling	IC Document
Appendix F Consent_clean_12-2-22.docx Appendix F: Consent	IC Document
Appendix F Consent_clean_12-2-22.docx Appendix F: Consent	IC Document
Appendix F Consent_Spanish_12-2-22.docx Appendix F: Consent Spanish	IC Document
Appendix F Consent_Spanish_12-2-22.docx Appendix F: Consent Spanish	IC Document
Appendix G Sources for HBCC-NSAC Toolkit development_clean_12-2-22.docx Appendix G: Sources for HBCC-NSAC Toolkit development	IC Document
Appendix G Sources for HBCC-NSAC Toolkit development_clean_12-2-22.docx Appendix G: Sources for HBCC-NSAC Toolkit development	IC Document
Appendix H HBCC-NSAC Toolkit English version pre-test summary_clean_12-2-22.docx Appendix H: HBCC-NSAC Toolkit English version pre-test summary	IC Document
Appendix H HBCC-NSAC Toolkit English version pre-test summary_clean_12-2-22.docx Appendix H: HBCC-NSAC Toolkit English version pre-test summary	IC Document
Appendix I Provider and family invitations_clean_12-2-22.docx Appendix I: Provider and family invitations	IC Document
Appendix I Provider and family invitations_clean_12-2-22.docx Appendix I: Provider and family invitations	IC Document
Appendix I Provider and family invitations_Spanish_12-2-22.docx Appendix I: Provider and family invitations Spanish	IC Document
Appendix I Provider and family invitations_Spanish_12-2-22.docx Appendix I: Provider and family invitations Spanish	IC Document
Appendix J Family data collection instructions_clean_12-2-22.docx Appendix J: Family data collection instructions	IC Document
Appendix J Family data collection instructions_clean_12-2-22.docx Appendix J: Family data collection instructions	IC Document
Appendix J Family data collection instructions_Spanish_12-2-22.docx Appendix J: Family data collection instructions Spanish	IC Document
Appendix J Family data collection instructions_Spanish_12-2-22.docx Appendix J: Family data collection instructions Spanish	IC Document
Appendix K Frequently asked questions_clean_12-2-22.docx Appendix K: Frequently asked questions	IC Document
Appendix K Frequently asked questions_clean_12-2-22.docx Appendix K: Frequently asked questions	IC Document
Appendix K Frequently asked questions_Spanish_12-2-22.docx Appendix K: Frequently asked questions Spanish	IC Document
Appendix K Frequently asked questions_Spanish_12-2-22.docx Appendix K: Frequently asked questions Spanish	IC Document
Appendix L Provider and family thank you letters_clean_12-2-22.docx Appendix L: Provider and family thank you letters	IC Document
Appendix L Provider and family thank you letters_clean_12-2-22.docx Appendix L: Provider and family thank you letters	IC Document
Appendix L Provider and family thank you letters_Spanish_12-2-22.docx Appendix L: Provider and family thank you letters Spanish	IC Document
Appendix L Provider and family thank you letters_Spanish_12-2-22.docx Appendix L: Provider and family thank you letters Spanish	IC Document
HBCCSQ CLIN 7 HBCC-NSAC Toolkit Pilot Study_SSA_clean_12-13-22.docx Home-Based Child Care Toolkit for Nurturing School-Age Children Pilot Study SSA	IC Document
HBCCSQ CLIN 7 HBCC-NSAC Toolkit Pilot Study_SSA_clean_12-13-22.docx Home-Based Child Care Toolkit for Nurturing School-Age Children Pilot Study SSA	IC Document
HBCCSQ CLIN 7 HBCC-NSAC Toolkit Pilot Study_SSB_clean_12-2-22.docx Home-Based Child Care Toolkit for Nurturing School-Age Children Pilot Study SSB	IC Document
HBCCSQ CLIN 7 HBCC-NSAC Toolkit Pilot Study_SSB_clean_12-2-22.docx Home-Based Child Care Toolkit for Nurturing School-Age Children Pilot Study SSB	IC Document
Instrument 1. Phase one provider telephone script and recruitment information collection_Spanish_12-2-22.docx Instrument 1: Phase one provider telephone script and recruitment information collection Spanish	IC Document
Instrument 1. Phase one provider telephone script and recruitment information collection_Spanish_12-2-22.docx Instrument 1: Phase one provider telephone script and recruitment information collection Spanish	IC Document
Instrument 2. Phase two provider telephone script and recruitment information collection_Spanish_12-2-22.docx Instrument 2: Phase two provider telephone script and recruitment information collection Spanish	IC Document
Instrument 2. Phase two provider telephone script and recruitment information collection_Spanish_12-2-22.docx Instrument 2: Phase two provider telephone script and recruitment information collection Spanish	IC Document
Instrument 3. HBCC-NSAC Toolkit Provider Questionnaire_Spanish_clean_12-7-22.docx Instrument 3: HBCC-NSAC Toolkit provider questionnaire Spanish	IC Document
Instrument 3. HBCC-NSAC Toolkit Provider Questionnaire_Spanish_clean_12-7-22.docx Instrument 3: HBCC-NSAC Toolkit provider questionnaire Spanish	IC Document
Instrument 4. HBCC-NSAC Toolkit Family Questionnaire_Spanish_clean_12-2-22.docx Instrument 4: HBCC-NSAC Toolkit family questionnaire Spanish	IC Document
Instrument 4. HBCC-NSAC Toolkit Family Questionnaire_Spanish_clean_12-2-22.docx Instrument 4: HBCC-NSAC Toolkit family questionnaire Spanish	IC Document
Instrument 5. Phase one provider cognitive interview guide_Spanish_12-2-22.docx Instrument 5: Phase one provider cognitive interview guide Spanish	IC Document
Instrument 5. Phase one provider cognitive interview guide_Spanish_12-2-22.docx Instrument 5: Phase one provider cognitive interview guide Spanish	IC Document
Instrument 6. Phase one family cognitive interview guide_Spanish_12-2-22.docx Instrument 6: Phase one family cognitive interview guide Spanish	IC Document
Instrument 6. Phase one family cognitive interview guide_Spanish_12-2-22.docx Instrument 6: Phase one family cognitive interview guide Spanish	IC Document
Instrument 7. Family data collection logistics call_Spanish_12-2-22.docx Instrument 7: Family data collection logistics call Spanish	IC Document
Instrument 7. Family data collection logistics call_Spanish_12-2-22.docx Instrument 7: Family data collection logistics call Spanish	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

The Home-Based Child Care Toolkit for Nurturing School-Age Children Pilot Study

Agency IC Tracking Number:

OPRE

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview Script	Instrument 1. Phase one provider telephone script and recruitment information collection_clean_12-2-22 .docx	Yes	Yes	Fillable Printable
Other-Interview Script	Instrument 2. Phase two provider telephone script and recruitment information collection_clean_12-2-22 .docx	Yes	Yes	Fillable Printable
Other-Questionnaire	Instrument 3. HBCC-NSAC Toolkit Provider Questionnaire_English_clean_12-7-22.docx	Yes	Yes	Fillable Printable
Other-Questionnaire	Instrument 4. HBCC-NSAC Toolkit Family Questionnaire_clean_12-2-22.docx	Yes	Yes	Paper Only
Other-Interview Guide	Instrument 5. Phase one provider cognitive interview guide_clean_12-2-22.docx	Yes	Yes	Fillable Fileable
Other-Interview Guide	Instrument 6. Phase one family cognitive interview guide_clean_12-2-22.docx	Yes	Yes	Fillable Fileable
Other-Logistical Interview	Instrument 7. Family data collection logistics call_clean_12-2-22.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 990

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	990	990
Annual IC Time Burden (Hours)	323	323
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix A: Community organization outreach materials	Appendix A Community organization outreach materials_clean_12-2-22.docx	12/14/2022
Appendix A: Community organization outreach materials Spanish	Appendix A Community organization outreach materials_Spanish_12-2-22.docx	12/14/2022
Appendix B: Phase one provider and family recruitment materials	Appendix B Phase one provider and family recruitment materials_clean_12-2-22.docx	12/14/2022
Appendix B: Phase one provider and family recruitment materials Spanish	Appendix B Phase one provider and family recruitment materials_Spanish_12-2-22.docx	12/14/2022
Appendix C: Phase two provider and family recruitment materials	Appendix C Phase two provider and family recruitment materials_clean_12-2-22.docx	12/14/2022
Appendix C: Phase two provider and family recruitment materials Spanish	Appendix C Phase two provider and family recruitment materials_Spanish_12-2-22.docx	12/14/2022
Appendix D: Supplemental provider and family recruitment materials	Appendix D Supplemental provider and family recruitment materials_clean_12-2-22.docx	12/14/2022
Appendix D: Supplemental provider and family recruitment materials Spanish	Appendix D Supplemental provider and family recruitment materials_Spanish_12-2-22.docx	12/14/2022
Appendix E: HBCC-NSAC Toolkit provider questionnaire matrix sampling	Appendix E HBCC-NSAC Toolkit provider questionnaire matrix sampling_clean_12-2-22.docx	12/14/2022
Appendix F: Consent	Appendix F Consent_clean_12-2-22.docx	12/14/2022
Appendix F: Consent Spanish	Appendix F Consent_Spanish_12-2-22.docx	12/14/2022
Appendix G: Sources for HBCC-NSAC Toolkit development	Appendix G Sources for HBCC-NSAC Toolkit development_clean_12-2-22.docx	12/14/2022
Appendix H: HBCC-NSAC Toolkit English version pre-test summary	Appendix H HBCC-NSAC Toolkit English version pre-test summary_clean_12-2-22.docx	12/14/2022
Appendix I: Provider and family invitations	Appendix I Provider and family invitations_clean_12-2-22.docx	12/14/2022
Appendix I: Provider and family invitations Spanish	Appendix I Provider and family invitations_Spanish_12-2-22.docx	12/14/2022
Appendix J: Family data collection instructions	Appendix J Family data collection instructions_clean_12-2-22.docx	12/14/2022
Appendix J: Family data collection instructions Spanish	Appendix J Family data collection instructions_Spanish_12-2-22.docx	12/14/2022
Appendix K: Frequently asked questions	Appendix K Frequently asked questions_clean_12-2-22.docx	12/14/2022
Appendix K: Frequently asked questions Spanish	Appendix K Frequently asked questions_Spanish_12-2-22.docx	12/14/2022
Appendix L: Provider and family thank you letters	Appendix L Provider and family thank you letters_clean_12-2-22.docx	12/14/2022
Appendix L: Provider and family thank you letters Spanish	Appendix L Provider and family thank you letters_Spanish_12-2-22.docx	12/14/2022
Home-Based Child Care Toolkit for Nurturing School-Age Children Pilot Study SSA	HBCCSQ CLIN 7 HBCC-NSAC Toolkit Pilot Study_SSA_clean_12-13-22.docx	12/14/2022
Home-Based Child Care Toolkit for Nurturing School-Age Children Pilot Study SSB	HBCCSQ CLIN 7 HBCC-NSAC Toolkit Pilot Study_SSB_clean_12-2-22.docx	12/14/2022
Instrument 1: Phase one provider telephone script and recruitment information collection Spanish	Instrument 1. Phase one provider telephone script and recruitment information collection_Spanish_12-2-22.docx	12/14/2022
Instrument 2: Phase two provider telephone script and recruitment information collection Spanish	Instrument 2. Phase two provider telephone script and recruitment information collection_Spanish_12-2-22.docx	12/14/2022
Instrument 3: HBCC-NSAC Toolkit provider questionnaire Spanish	Instrument 3. HBCC-NSAC Toolkit Provider Questionnaire_Spanish_clean_12-7-22.docx	12/14/2022
Instrument 4: HBCC-NSAC Toolkit family questionnaire Spanish	Instrument 4. HBCC-NSAC Toolkit Family Questionnaire_Spanish_clean_12-2-22.docx	12/14/2022
Instrument 5: Phase one provider cognitive interview guide Spanish	Instrument 5. Phase one provider cognitive interview guide_Spanish_12-2-22.docx	12/14/2022
Instrument 6: Phase one family cognitive interview guide Spanish	Instrument 6. Phase one family cognitive interview guide_Spanish_12-2-22.docx	12/14/2022
Instrument 7: Family data collection logistics call Spanish	Instrument 7. Family data collection logistics call_Spanish_12-2-22.docx	12/14/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.