Information Collection

Family Partners for Research Study

IC 269109 under ICR 202607-0970-011 · OMB 0970-0356.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

IC Status: Modified

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-Child Assessment Parent Report	Yes	Yes	Fillable Fileable
Other-Questionnaire	Yes	Yes	Fillable Fileable
Other-Child Assessment - Interviewer Administered	Yes	Yes	Fillable Fileable
Other-Play Session	Yes	Yes	Fillable Fileable
Other-Interview	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: 140

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	700	700
Annual IC Time Burden (Hours)	197	197
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA - Formative Research GenIC: Family Partners for Research Study		07/01/2024
SSB - Formative Research GenIC: Family Partners for Research Study		07/01/2024

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

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