Information Collection

Center for Indigenous Research Collaborations and Learning in Home Visiting (CIRCLE-HV)

IC 278673 under ICR 202504-0970-028 · OMB 0970-0356.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 1 Caregiver Survey_v3_clean.docx	Other-Survey
Instrument 2 Home Visitor Survey_v3_clean.docx	Other-Survey
Instrument 3 Program Leader Survey_v3_clean.docx	Other-Survey
Instrument 4 Caregiver Interview Protocol_v2_clean.docx	Other-Interview Protocol
Instrument 5 Home Visitor Interview Protocol_v2_clean.docx	Other-Interview Protocol
Instrument 6 Program Leader Interview Protocol_v2_clean.docx	Other-Interview Protocol
Supporting Statement A_Generic Research_CSS_v7_clean-12-22-25.docx SSA Research GenIC - CIRCLE-HV	IC Document
Supporting Statement B_Generic Research_CSS_v7_clean.docx SSB Research GenIC - CIRCLE-HV	IC Document
Outreach Appendices A - D.docx Outreach Appendices A-D	IC Document
Appendix E- CIRCLE-HV Survey Consent_v3_clean.docx Appendix E: CIRCLE-HV Survey Consent Form	IC Document
Appendix F- CIRCLE-HV Interview Consent_v3_clean.docx Appendix F: CIRCLE-HV Interview Consent Form	IC Document

IC Title:

Agency IC Tracking Number:

OPRE

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	Yes	Yes	Fillable Fileable
Other-Survey	Yes	Yes	Fillable Fileable
Other-Survey	Yes	Yes	Fillable Fileable
Other-Interview Protocol	Yes	Yes	Printable Only
Other-Interview Protocol	Yes	Yes	Printable Only
Other-Interview Protocol	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: 211

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	285	285
Annual IC Time Burden (Hours)	162	162
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA Research GenIC - CIRCLE-HV		01/08/2026
SSB Research GenIC - CIRCLE-HV		01/08/2026
Outreach Appendices A-D		01/08/2026
Appendix E: CIRCLE-HV Survey Consent Form		01/08/2026
Appendix F: CIRCLE-HV Interview Consent Form		01/08/2026

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

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