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Family Partners for Research Study
Formative Data Collections for ACF Research
OMB: 0970-0356
IC ID: 269109
OMB.report
HHS/ACF
OMB 0970-0356
ICR 202504-0970-028
IC 269109
( )
Documents and Forms
Document Name
Document Type
Instrument 1 - Parent Pre-Screener and Screening Call_revised_6.27.24_Clean.docx
Other-Screener
Instrument 2 - Remote Child Well-Being Assessment by Parent Report_revised_6.27.24_Clean.docx
Other-Child Assessment Parent Report
Instrument 3 - Online Parent Feedback Questionnaire 6.19.24_CLEAN.docx
Other-Questionnaire
Instrument 4 - Parent In-Person Interviewer-Administered Child WellBeing Assessment 6_27_24_Clean.docx
Other-Child Assessment - Interviewer
Instrument 5 - Child - In-Person Interviewer-Administered Play Session 6.19.24_CLEAN.docx
Other-Play Session
Instrument 6 - In-Person Parent Feedback Interview 6.19.24_CLEAN.docx
Other-Interview
Reimagining NSCAW Multi-Mode SSA 6.19.24_CLEAN.docx
SSA - Formative Research GenIC: Family Partners for Research Study
IC Document
Reimagining NSCAW Multi-Mode SSB 6.25.24_CLEAN.docx
SSB - Formative Research GenIC: Family Partners for Research Study
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Family Partners for Research Study
Agency IC Tracking Number:
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 - Parent Pre-Screener and Screening Call_revised_6.27.24_Clean.docx
Yes
Yes
Fillable Fileable
Other-Child Assessment Parent Report
Instrument 2 - Remote Child Well-Being Assessment by Parent Report_revised_6.27.24_Clean.docx
Yes
Yes
Fillable Fileable
Other-Questionnaire
Instrument 3 - Online Parent Feedback Questionnaire 6.19.24_CLEAN.docx
Yes
Yes
Fillable Fileable
Other-Child Assessment - Interviewer Administered
Instrument 4 - Parent In-Person Interviewer-Administered Child WellBeing Assessment 6_27_24_Clean.docx
Yes
Yes
Fillable Fileable
Other-Play Session
Instrument 5 - Child - In-Person Interviewer-Administered Play Session 6.19.24_CLEAN.docx
Yes
Yes
Fillable Fileable
Other-Interview
Instrument 6 - In-Person Parent Feedback Interview 6.19.24_CLEAN.docx
Yes
Yes
Printable 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:
140
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
80 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
700
0
0
0
0
700
Annual IC Time Burden (Hours)
197
0
0
0
0
197
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA - Formative Research GenIC: Family Partners for Research Study
Reimagining NSCAW Multi-Mode SSA 6.19.24_CLEAN.docx
07/01/2024
SSB - Formative Research GenIC: Family Partners for Research Study
Reimagining NSCAW Multi-Mode SSB 6.25.24_CLEAN.docx
07/01/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.