Information Collection

Multi-Site Study of State-Tribal Collaboration in Home Visiting

IC 254587 under ICR 202508-0970-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 A - MUSE-STC Interview Protocol_OMB_clean_fnl.docx	Other-Interview Protocol
Generics Supporting Statement A - MUSE-STC_OMB_clean_OMB_ACF_clean.docx SSA Prog Supp GenIC - Multi-Site Study of State-Tribal Collaboration in Home Visiting	IC Document
Generics Supporting Statement B - MUSE-STC_OMB_clean.docx SSB Prog Supp GenIC - Multi-Site Study of State-Tribal Collaboration in Home Visiting	IC Document
Appendix A - MUSE-STC Draft Interview Recruitment Email and Phone Script_OMB.docx APPENDIX A: Draft Recruitment Email and Call Script	IC Document
Appendix B -Study Notification Email from Health Resources and Services Administration_OMB_clean.docx APPENDIX B: Draft Study Notification Email from Health Resources and Services Administration	IC Document
Appendix C - MUSE-STC Site Engagement Email_OMB.docx APPENDIX C: MUSE-STC Site Engagement Email	IC Document
Appendix D - MUSE-STC research flyer_OMB_clean.docx APPENDIX D: MUSE-STC Research Flyer	IC Document
Appendix E - MUSE-STC Consent Form_OMB_clean.docx APPENDIX E: MUSE-STC Consent Form	IC Document
NOA_MUSE Formative GenIC Prog Supp_0970-0531_6.22.22.pdf NOA_MUSE Formative GenIC Prog Supp	IC Document

IC Title:

Multi-Site Study of State-Tribal Collaboration in Home Visiting

Agency IC Tracking Number:

OPRE

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
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: 42

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	42	42
Annual IC Time Burden (Hours)	63	63
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA Prog Supp GenIC - Multi-Site Study of State-Tribal Collaboration in Home Visiting		07/11/2022
SSB Prog Supp GenIC - Multi-Site Study of State-Tribal Collaboration in Home Visiting		07/11/2022
APPENDIX A: Draft Recruitment Email and Call Script		07/11/2022
APPENDIX B: Draft Study Notification Email from Health Resources and Services Administration		07/11/2022
APPENDIX C: MUSE-STC Site Engagement Email		07/11/2022
APPENDIX D: MUSE-STC Research Flyer		07/11/2022
APPENDIX E: MUSE-STC Consent Form		07/11/2022
NOA_MUSE Formative GenIC Prog Supp		07/11/2022

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].