"Research Ready Grantee" Intake Form

Title: Research Interest Form for ACF Grant Recipients

Introductory text:

ACF continuously conducts various research activities with grant recipients to learn more and develop solutions for improvement. We would like to invite you to opt-in to these activities. By joining this list, ACF may contact you in the future for a research opportunity, where you will have the chance to provide valuable feedback that will directly influence ACF’s work. Thank you for your time and willingness to contribute to the continuous improvement of ACF’s programs and services.

PAPERWORK REDUCTION ACT OF 1995 (Public Law 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to collect contact information of grant recipients who are interested in participating in future research opportunities with ACF. Public reporting burden for this collection of information is estimated to average 5 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 [email protected].

Questions:

1. Your name?

   1. Format: Open-text

2. Your title and organization?

   1. Format: Open-text

3. Your email?

   1. Format: Open-text

4. Which of these best describes your organization?

   1. Format: Radio button

   2. Options:

      1. State government

      2. Territorial government

      3. Tribal government

      4. Non-profit

5. Which of these programs do you have experience with?

   1. Format: Checkboxes

   2. Options:

      1. (all major ACF programs, with an “Other “ option)

6. Are there any topics you would be particularly interested in discussing with ACF?

   1. Format: Open-text