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Strategies To Respond to Intimate Violence Effectively (STRIVE)
Formative Data Collections for ACF Program Support
OMB: 0970-0531
IC ID: 274132
OMB.report
HHS/ACF
OMB 0970-0531
ICR 202507-0970-008
IC 274132
( )
Documents and Forms
Document Name
Document Type
Instrument 1. HMRE pre and post survey.docx
Other-Survey
Instrument 2. RF pre and post survey.docx
Other-Survey
Instrument 3. Contact information form.docx
Other-Contact info
Instrument 4. Implementation log.docx
Other-log
Instrument 5. Interview protocol for HMRF staff.docx
Other-Interview protocol
STRIVE_Formative ACF Program Support_SSA_CLEAN.docx
SSA Prog Support - STRIVE
IC Document
STRIVE_Formative ACF Program Support_SSB_clean.docx
SSB Prog Support - STRIVE
IC Document
Attachment A. Study consent form for HMRF participants.docx
Attachment A. Study consent form for HMRF participants
IC Document
Attachment B. Study consent form for HMRF staff interviews.docx
Attachment B. Study consent form for HMRF staff interviews
IC Document
Attachment C. CUES safety card_HMRE programs.docx
Attachment C. CUES safety card_HMRE programs
IC Document
Attachment D. CUES safety card_RF programs.docx
Attachment D. CUES safety card_RF programs
IC Document
Attachment E. CUES safety card_AIAN participants CLEAN.docx
Attachment E. CUES safety card_AIAN participants
IC Document
Attachment F. Information and outreach scripts.docx
Attachment F. Information and outreach scripts
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Strategies To Respond to Intimate Violence Effectively (STRIVE)
Agency IC Tracking Number:
OPRE
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-Survey
Instrument 1. HMRE pre and post survey.docx
Yes
Yes
Fillable Fileable
Other-Survey
Instrument 2. RF pre and post survey.docx
Yes
Yes
Fillable Fileable
Other-Contact info
Instrument 3. Contact information form.docx
Yes
Yes
Fillable Fileable
Other-log
Instrument 4. Implementation log.docx
Yes
Yes
Fillable Fileable
Other-Interview protocol
Instrument 5. Interview protocol for HMRF staff.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:
356
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
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
392
0
0
0
0
392
Annual IC Time Burden (Hours)
175
0
0
0
0
175
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA Prog Support - STRIVE
STRIVE_Formative ACF Program Support_SSA_CLEAN.docx
02/25/2025
SSB Prog Support - STRIVE
STRIVE_Formative ACF Program Support_SSB_clean.docx
02/25/2025
Attachment A. Study consent form for HMRF participants
Attachment A. Study consent form for HMRF participants.docx
02/25/2025
Attachment B. Study consent form for HMRF staff interviews
Attachment B. Study consent form for HMRF staff interviews.docx
02/25/2025
Attachment C. CUES safety card_HMRE programs
Attachment C. CUES safety card_HMRE programs.docx
03/06/2025
Attachment D. CUES safety card_RF programs
Attachment D. CUES safety card_RF programs.docx
02/25/2025
Attachment E. CUES safety card_AIAN participants
Attachment E. CUES safety card_AIAN participants CLEAN.docx
03/06/2025
Attachment F. Information and outreach scripts
Attachment F. Information and outreach scripts.docx
02/25/2025
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.