Healthy Marriage and Responsible Fatherhood Local Evaluation Final Report Templates

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Supporting Statement A_HMRF Local Eval Final Rpts_21Nov2024_Clean - final.docx	Supporting Statement A	Uploaded 2024-12-03	Available
Supporting Statement A_HMRF Local Eval Final Rpts_21Nov2024_Clean - final.docx	Supporting Statement A	Uploaded 2024-12-03	Missing upstream
Appendix D_Impact Evaluation Final Report Dissemination Email.docx	Supplementary Document	Uploaded 2024-12-03	Available
Appendix D_Impact Evaluation Final Report Dissemination Email.docx	Supplementary Document	Uploaded 2024-12-03	Repair queued
Appendix C_Descriptive Evaluation Final Report Dissemination Email.docx	Supplementary Document	Uploaded 2024-12-03	Repair queued
Appendix C_Descriptive Evaluation Final Report Dissemination Email.docx	Supplementary Document	Uploaded 2024-12-03	Repair queued
Appendix B_Instructions for the Impact Evaluation Final Report Template.docx	Supplementary Document	Uploaded 2024-12-03	Available
Appendix B_Instructions for the Impact Evaluation Final Report Template.docx	Supplementary Document	Uploaded 2024-12-03	Repair queued
Appendix A_Instructions for the Descriptive Evaluation Final Report Template.docx	Supplementary Document	Uploaded 2024-12-03	Available
Appendix A_Instructions for the Descriptive Evaluation Final Report Template.docx	Supplementary Document	Uploaded 2024-12-03	Missing upstream

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
272760	Instrument 3: Impact Evaluation Final Report Table Shells	Other-Report Table Shells	New
272759	Instrument 2: Impact Evaluation Final Report Template	Other-Report Template	New
272758	Instrument 1: Descriptive Evaluation Final Report Template	Other-Report Template	New

ICR Details

OMB Control No: 0970-0640	ICR Reference No: 202412-0970-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Healthy Marriage and Responsible Fatherhood Local Evaluation Final Report Templates
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/08/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/06/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2026	15 Months From Approved
Responses	108	0	0
Time Burden (Hours)	3,160	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services (HHS) seeks approval of the Healthy Marriage and Responsible Fatherhood (HMRF) Final Report Templates. HMRF grant recipients carrying out local evaluations of their programs are required to submit a final evaluation report to ACF at the end of their grant. This request includes templates for grant recipients to use to document their evaluation’s analysis and findings. In addition, the information collected in the final report templates will inform technical assistance provided to grant recipients as they develop the final reports to ACF to fulfill the grant requirement.

---

Authorizing Statute(s): US Code: 42 USC 603(a)(2) Name of Law: Public Health and Welfare; Use of Grants
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 80904	10/04/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 97010	12/06/2024
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Instrument 1: Descriptive Evaluation Final Report Template
Instrument 2: Impact Evaluation Final Report Template
Instrument 3: Impact Evaluation Final Report Table Shells

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	108	0	0	108	0	0
Annual Time Burden (Hours)	3,160	0	0	3,160	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection request.

---

Annual Cost to Federal Government: $353,148

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/06/2024

---