Success Sequence Interviews – Pre-Test

Pre-testing of Evaluation Data Collection Activities

OMB: 0970-0355

IC ID: 249159

⚠️ Notice: This information collection may be referencing outdated material.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. Success Sequence Pre-test Screener 8.27.21_clean.docx Other-Screener
Instrument 1. Success Sequence Pre-test Screener 8.27.21_clean.docx Other-Screener
Instrument 2. Success Sequence Pre-Test Interview and Debrief Protocol 8.27.21_clean.docx Other-Interview and Debrief Protocol
Instrument 2. Success Sequence Pre-Test Interview and Debrief Protocol 8.27.21_clean.docx Other-Interview and Debrief Protocol
SSA Success Sequence Cog Pretesting.Aug 2021.docx SSA - Pretesting GenIC: Success Sequence IC Document
SSA Success Sequence Cog Pretesting.Aug 2021.docx SSA - Pretesting GenIC: Success Sequence IC Document
Success Sequence Generic SSB for Pre-test 8.27.21_clean (002).docx SSB - Pretesting GenIC: Success Sequence IC Document
Success Sequence Generic SSB for Pre-test 8.27.21_clean (002).docx SSB - Pretesting GenIC: Success Sequence IC Document
Appendix A. Success Sequence Pre-test Recruitment Materials 8.27.21_clean.docx Appendix A. Success Sequence Pre-test Recruitment Materials IC Document
Appendix A. Success Sequence Pre-test Recruitment Materials 8.27.21_clean.docx Appendix A. Success Sequence Pre-test Recruitment Materials IC Document
Appendix B. Pre-test Consent Form 8.27.21_clean.docx Appendix B. Pre-test Consent Form IC Document
Appendix B. Pre-test Consent Form 8.27.21_clean.docx Appendix B. Pre-test Consent Form IC Document
Appendix C. QualBoard Invitation Email Sample Screen Shots.docx Appendix C. QualBoard Invitation Email Sample Screen Shots IC Document
Appendix C. QualBoard Invitation Email Sample Screen Shots.docx Appendix C. QualBoard Invitation Email Sample Screen Shots IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Success Sequence Interviews – Pre-Test	Agency IC Tracking Number:	OPRE

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener			Instrument 1. Success Sequence Pre-test Screener 8.27.21_clean.docx		Yes	Yes	Fillable Fileable
Other-Interview and Debrief Protocol			Instrument 2. Success Sequence Pre-Test Interview and Debrief Protocol 8.27.21_clean.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: 120	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	160	160
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA - Pretesting GenIC: Success Sequence	SSA Success Sequence Cog Pretesting.Aug 2021.docx	09/02/2021
SSB - Pretesting GenIC: Success Sequence	Success Sequence Generic SSB for Pre-test 8.27.21_clean (002).docx	09/02/2021
Appendix A. Success Sequence Pre-test Recruitment Materials	Appendix A. Success Sequence Pre-test Recruitment Materials 8.27.21_clean.docx	09/02/2021
Appendix B. Pre-test Consent Form	Appendix B. Pre-test Consent Form 8.27.21_clean.docx	09/02/2021
Appendix C. QualBoard Invitation Email Sample Screen Shots	Appendix C. QualBoard Invitation Email Sample Screen Shots.docx	09/02/2021

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