Information Collection

Personal Responsibility Education Program (PREP) Local Evaluation Support Instruments

IC 271786 under ICR 202412-0970-005 · OMB 0970-0531.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0531 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 1 - State PREP and Competitive PREP Grantee Evaluation Activities Survey_10.3.24.docx	Other-Survey
Instrument 2 - PREIS Analysis Plan Template (002).docx	Other-Template
Instrument 3 - Sample Enrollment Progress Tool - Individual Assignment.xlsx	Other-Progress Tool
Instrument 4 - Sample Enrollment Progress Tool - Cluster Assignment.xlsx	Other-Progress Tool
SPREP CPREP PREIS OMB - SSA 10.22.24 CLEAN.docx SSA - PREP Local Evaluation Support Instruments	IC Document
SPREP CPREP PREIS OMB - SSB 10.22.24 CLEAN.docx SSB - PREP Local Evaluation Support Instruments	IC Document
Appendix A - Invitation email for State and CPREP grantees survey.docx Appendix A - Invitation email for State and CPREP grantees survey	IC Document
Appendix B - Individual Assignment Tool Instructions - CLEAN.docx Appendix B - Individual Assignment Tool Instructions	IC Document
Appendix C - Cluster Assignment Tool Instructions -CLEAN.docx Appendix C - Cluster Assignment Tool Instructions	IC Document
Appendix D - PREIS Analysis Plan Template email - CLEAN.docx Appendix D - PREIS Analysis Plan Template email	IC Document
Appendix E - Sample Enrollment Progress Tool email - CLEAN.docx Appendix E - Sample Enrollment Progress Tool email	IC Document

IC Title:

Personal Responsibility Education Program (PREP) Local Evaluation Support Instruments

Agency IC Tracking Number:

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-Survey	Instrument 1 - State PREP and Competitive PREP Grantee Evaluation Activities Survey_10.3.24.docx	Yes	Yes	Fillable Fileable
Other-Template	Instrument 2 - PREIS Analysis Plan Template (002).docx	Yes	Yes	Fillable Fileable
Other-Progress Tool	Instrument 3 - Sample Enrollment Progress Tool - Individual Assignment.xlsx	Yes	Yes	Fillable Fileable
Other-Progress Tool	Instrument 4 - Sample Enrollment Progress Tool - Cluster Assignment.xlsx	Yes	Yes	Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 218

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: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	262	262
Annual IC Time Burden (Hours)	184	184
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA - PREP Local Evaluation Support Instruments	SPREP CPREP PREIS OMB - SSA 10.22.24 CLEAN.docx	10/22/2024
SSB - PREP Local Evaluation Support Instruments	SPREP CPREP PREIS OMB - SSB 10.22.24 CLEAN.docx	10/22/2024
Appendix A - Invitation email for State and CPREP grantees survey	Appendix A - Invitation email for State and CPREP grantees survey.docx	10/22/2024
Appendix B - Individual Assignment Tool Instructions	Appendix B - Individual Assignment Tool Instructions - CLEAN.docx	10/22/2024
Appendix C - Cluster Assignment Tool Instructions	Appendix C - Cluster Assignment Tool Instructions -CLEAN.docx	10/22/2024
Appendix D - PREIS Analysis Plan Template email	Appendix D - PREIS Analysis Plan Template email - CLEAN.docx	10/22/2024
Appendix E - Sample Enrollment Progress Tool email	Appendix E - Sample Enrollment Progress Tool email - CLEAN.docx	10/22/2024

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