Information Collection

Supporting Family Economic Well-Being through Home Visiting (HomeEc) Formative Evaluation

IC 269199 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⚠️ Notice: This information collection may be referencing outdated material.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 1. Program Recruitment and Eligibility Screener.docx	Other-Screener
Instrument 2. Interview guide for needs identification.docx	Other-Interview Guide
Instrument 3. Discussion guide for strategic planning meetings.docx	Other-Discussion Guide
Instrument 4. Interview Guide for Learning Cycles.docx	Other-Interview Guide
Instrument 5. Caregiver participant survey for learning cycles.docx	Other-Survey
Instrument 6. Staff survey for learning cycles.docx	Other-Survey
HomeEc OSC3 Formative ACF Program Support_0970-0531_SSA GenIC.docx SSA - Program Support GenIC: HomeEc Formative Evaluation	IC Document
HomeEc OSC3 Formative ACF Program Support_0970-0531_SSB GenIC_CLEAN.docx SSB - Program Support GenIC: HomeEc Formative Evaluation	IC Document
Appendix A. Invitation to Participate in Recruitment Screener.docx Appendix A. Invitation to Participate in Recruitment Screener	IC Document
Appendix B. Formative Evaluation Information.docx Appendix B. Formative Evaluation Information	IC Document

IC Title:

Supporting Family Economic Well-Being through Home Visiting (HomeEc) Formative Evaluation

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener	Yes	Yes	Fillable Fileable
Other-Interview Guide	Yes	Yes	Printable Only
Other-Discussion Guide	Yes	Yes	Printable Only
Other-Interview Guide	Yes	Yes	Printable Only
Other-Survey	Yes	Yes	Fillable Fileable
Other-Survey	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 292

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	876	876
Annual IC Time Burden (Hours)	222	222
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA - Program Support GenIC: HomeEc Formative Evaluation		07/05/2024
SSB - Program Support GenIC: HomeEc Formative Evaluation		07/05/2024
Appendix A. Invitation to Participate in Recruitment Screener		07/05/2024
Appendix B. Formative Evaluation Information		07/05/2024

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

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