Touchpoints for Addressing Substance Use Issues in Home Visiting: Performance Measurement Pilot

Pre-testing of Evaluation Data Collection Activities

OMB: 0970-0355

IC ID: 247483

⚠️ Notice: This information collection may be referencing outdated material.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

2025-03-28 - No material or nonsubstantive change to a currently approved collection
2024-12-13 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
Instrument 1_SUD1 and SUD2 Measures Reporting Tool.xlsx Other-Reporting Tool
Instrument 1_SUD1 and SUD2 Measures Reporting Tool.xlsx Other-Reporting Tool
Instrument 2_Interview Protocol_State Awardees.docx Other-Interview Protocol
Instrument 2_Interview Protocol_State Awardees.docx Other-Interview Protocol
Instrument 3_Interview Protocol_LIA Managers and Data Managers, Home Visiting Supervisors, and Home Visitors.docx Other-Interview Protocol
Instrument 3_Interview Protocol_LIA Managers and Data Managers, Home Visiting Supervisors, and Home Visitors.docx Other-Interview Protocol
Instrument 4_Interview Protocol_Home-Visiting-Model Representatives.docx Other-Interview Protocol
Instrument 4_Interview Protocol_Home-Visiting-Model Representatives.docx Other-Interview Protocol
Generic SSA_Touchpoints_Pretesting.docx Supporting Statement A - Touchpoints Pretesting GenIC IC Document
Generic SSA_Touchpoints_Pretesting.docx Supporting Statement A - Touchpoints Pretesting GenIC IC Document
Generic SSB_Touchpoints_Pretesting.docx Supporting Statement B - Touchpoints Pretesting GenIC IC Document
Generic SSB_Touchpoints_Pretesting.docx Supporting Statement B - Touchpoints Pretesting GenIC IC Document
Appendix A_Pilot Study FAQs.docx Appendix A_Pilot Study FAQs IC Document
Appendix A_Pilot Study FAQs.docx Appendix A_Pilot Study FAQs IC Document
Appendix B_Invitations to Participate in the Study.docx Appendix B_Invitations to Participate in the Study IC Document
Appendix B_Invitations to Participate in the Study.docx Appendix B_Invitations to Participate in the Study IC Document
Appendix C_Research Questions Addressed by Interview Protocols.docx Appendix C_Research Questions Addressed by Interview Protocols IC Document
Appendix C_Research Questions Addressed by Interview Protocols.docx Appendix C_Research Questions Addressed by Interview Protocols IC Document
NOA - Pretesting_Touchpoints GenIC_3.20.21.pdf NOA - Touchpoints Pretesting GenIC IC Document
NOA - Pretesting_Touchpoints GenIC_3.20.21.pdf NOA - Touchpoints Pretesting GenIC IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Touchpoints for Addressing Substance Use Issues in Home Visiting: Performance Measurement Pilot	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Reporting Tool	Instrument 1_SUD1 and SUD2 Measures Reporting Tool.xlsx	Yes	Yes	Fillable Fileable
Other-Interview Protocol	Instrument 2_Interview Protocol_State Awardees.docx	No		Paper Only
Other-Interview Protocol	Instrument 3_Interview Protocol_LIA Managers and Data Managers, Home Visiting Supervisors, and Home Visitors.docx	No		Paper Only
Other-Interview Protocol	Instrument 4_Interview Protocol_Home-Visiting-Model Representatives.docx	No		Paper Only

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: 56	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	87	87
Annual IC Time Burden (Hours)	73	73
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A - Touchpoints Pretesting GenIC	Generic SSA_Touchpoints_Pretesting.docx	05/18/2021
Supporting Statement B - Touchpoints Pretesting GenIC	Generic SSB_Touchpoints_Pretesting.docx	05/18/2021
Appendix A_Pilot Study FAQs	Appendix A_Pilot Study FAQs.docx	05/18/2021
Appendix B_Invitations to Participate in the Study	Appendix B_Invitations to Participate in the Study.docx	05/18/2021
Appendix C_Research Questions Addressed by Interview Protocols	Appendix C_Research Questions Addressed by Interview Protocols.docx	05/18/2021
NOA - Touchpoints Pretesting GenIC	NOA - Pretesting_Touchpoints GenIC_3.20.21.pdf	05/18/2021

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