OPRE OMB Clearance Manual

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National Child Welfare Center for Innovation 
and Advancement   
Service Request Form



Formative Data Collections for Program Support

0970–0531


Supporting Statement
Part A - Justification
April 2026

Submitted By:
Children’s Bureau
Administration for Children and Families 
U.S. Department of Health and Human Services

4th Floor, Mary E. Switzer Building
330 C Street, SW
Washington, DC 20201




A1. Necessity for the Data Collection
The Administration for Children and Families (ACF) within the U.S. Department of Health and Human Services (HHS) proposes a form for child welfare agencies to use to request information, services, and resources from the Children’s Bureau’s (CB’s) current technical assistance provider, the National Child Welfare Center for Innovation and Advancement (NCWCIA). 

Background 
NCWCIA is funded by the CB to partner with child welfare agencies to provide them with data-driven technical assistance, resources, and innovative strategies to improve safety, permanency, and well-being outcomes for children and families. Providing a way for agencies to identify their needs and request NCWCIA services followed by timely and responsive communication by NCWCIA is critical for child welfare agencies to easily access services that are comprehensive and coordinated across NCWCIA. NCWCIA has designed a low-burden, online service request form for agencies to indicate their interest in engagement and the type of service(s) they wish to pursue. NCWCIA staff subsequently reach out to the requestor to begin the conversation for partnership.

Legal or Administrative Requirements that Necessitate the Collection 
There are no legal or administrative requirements that necessitate the collection. ACF is undertaking the collection at the discretion of the agency.

A2. Purpose of Survey and Data Collection Procedures
Overview of Purpose and Use
The purpose of the proposed online service request form is to inform NCWCIA of an agency’s interest in engagement and the services it is seeking and inform CB of the needs of child welfare agencies. The information collected will enable NCWCIA to initiate engagement and collaborate with child welfare agency staff to align services with identified needs. 

Aggregate data will be summarized and reported on a monthly and annual basis to inform NCWCIA and CB leadership of emerging needs, trends, and requests across agencies. Agency-specific data may also be included in individualized work plans and technical assistance activities. 

Information collected under this effort is intended to inform ACF activities and may be incorporated into documents or presentations that are made public, such as infographics, project-specific reports, or other materials relevant to Federal leadership. For example, frequencies and types of NCWCIA services that child welfare agencies request may be incorporated into presentations about the needs of child welfare agencies and the way in which ACF supports them through NCWCIA. 

Data shared with the CB will include the appropriate context on data collection and reporting methods, along with any relevant limitations, including the extent to which findings can be generalized. This proposed information collection meets the following goals of ACF’s generic clearance for formative data collections for program support (0970-0531): 
    • Delivery of TA and/or workflows related to NCWCIA implementation or the development or refinement of program processes
    • Planning for provision of programmatic T/TA through NCWCIA 
    • Informing NCWCIA performance measures   

Processes for Information Collection 
Data will be collected through NCWCIA’s platform, which is an authorization to operate (ATO)-approved website that provides an overview of NCWCIA with links to request services and explore resources. Individuals may volunteer to click the link to request services and complete the service request form, which is a brief questionnaire. A welcome message and directions for completing the form appear at the top of the document. Once completed and submitted via a secure link, data will be stored on the NCWCIA ATO-approved platform and made accessible to authorized NCWCIA staff. NCWCIA will then initiate a conversation with the child welfare agency to gather additional information and collaboratively determine and implement a course of action.

A3. Improved Information Technology to Reduce Burden
NCWCIA’s ATO-approved online platform streamlines the service request process by providing child welfare agencies with the ability to complete and submit their requests electronically via a secure link in 5 minutes or less and receive a targeted, follow-up response within 2 business days.

A4. Efforts to Identify Duplication
Service request information is not available elsewhere.

A5. Involvement of Small Organizations
Service request information is not available elsewhere.

A6. Consequences of Less Frequent Data Collection
Data will be collected when an agency would like to request information, a service, or a resource. Less frequent data collection is not applicable to this OMB request.

A7. Special Circumstances
There are no special circumstances for the proposed data collection efforts.

A8. Federal Register Notice and Consultation
Federal Register Notice and Comments
In accordance with the Paperwork Reduction Act of 1995 (Pub. L. 104-13) and Office of Management and Budget (OMB) regulations at 5 CFR Part 1320 (60 FR 44978, August 29, 1995), ACF published a notice in the Federal Register announcing the agency’s intention to request an OMB review of this information collection request to extend approval of the umbrella generic with minor changes. The notice was published on April 28, 2025, (90 FR 17603), and provided a sixty-day period for public comment. ACF did not receive any comments on the first notice. A second notice was published, allowing a thirty-day period for public comment (90 FR 42248, in conjunction with submission of the request to OMB). ACF did not receive any comments on the second notice.

Consultation with Outside Experts
No consultations have taken place with experts outside of the project team.

A9. Tokens of Appreciation for Respondents
No tokens of appreciation for respondents are proposed for this information collection.

A10. Privacy of Respondents
Personally identifiable information (PII) in the form of respondents’ contact information will be collected. PII data are necessary for NCWCIA and child welfare agencies to connect and engage and for information, services, or resources to be delivered. Information collected will be kept private to the extent permitted by law. Respondents will be informed that the data provided will only be used by NCWCIA to identify service requests and inform what NCWCIA resources and services are needed, that their participation is voluntary, and that their information will be kept private and accessible only to NCWCIA staff. 

Information will not be maintained in a paper or electronic system from which data are actually or directly retrieved by an individuals’ personal identifier.

A11. Sensitive Questions
There are no sensitive questions in this data collection.

A12. Estimation of Information Collection Burden
Burden Estimates
Burden estimates were calculated based upon the amount of time an individual would need to complete the service request form. Completion of the service request form will take an average of 5 minutes per response, with an estimated 148 respondents per year. Respondent estimates are based on the number of tailored service (technical assistance) inquires (n = 100) and resource (e.g., toolkits) requests (n = 48) in a year, informed by insights from the previous Capacity Building Center for States. Combined, N = 148 respondents are estimated to complete the form.

Cost Estimates
The annual cost to respondents was calculated using the Bureau of Labor Statistics (BLS) job code for social and community service managers [11-9151] and wage data from May 2024, which is $41.39 per hour. To account for fringe benefits and overhead, the rate was multiplied by two, which is $82.78. 

Instrument
Total Number of Respondents
Total Number of Responses Per Respondent
Average Burden Hours Per Response
Total
Burden Hours
Average Hourly Wage
Total Annual Cost
Service request form
148
1
0.083
12.28
82.78
$1,016.54

A13. Cost Burden to Respondents or Record Keepers
There are no additional costs to respondents.

A14. Estimate of Cost to the Federal Government
The total annual cost for the data collection activities under this current request is estimated to be $1,643.40. 

A15. Change in Burden
This is for an individual information collection under the umbrella formative generic clearance for program support (0970-0531).

A16. Plan and Time Schedule for Information Collection, Tabulation and Publication
Upon receiving OMB clearance, the online request form will be accessible to agencies to submit individual requests for information, resources, or services from NCWCIA. 

Data will be tabulated monthly and submitted in NCWCIA’s monthly progress reports to the CB and aggregated yearly and submitted in NCWCIA’s annual progress report to the CB. Data may also be used in work plans when technical assistance is provided. Data may also be included in CB-authored reports. Data collection procedures will be provided any time data are shared (e.g., CB requests data).   

A17. Reasons Not to Display OMB Expiration Date
All instruments will display the expiration date for OMB approval.

A18. Exceptions to Certification for Paperwork Reduction Act Submissions
No exceptions are necessary for this information collection.	

Attachments
Instrument1_NCWCIA Service Request Form