OPRE OMB Clearance Manual

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National Center on Substance Abuse 
and Child Welfare   
Technical Assistance Request Form



Formative Data Collections for Program Support

0970–0531


Supporting Statement
Part A - Justification
May 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 individuals and agencies to request information, technical assistance (TA), and resources from a Children’s Bureau’s (CB’s) TA provider, the National Center on Substance Abuse and Child Welfare (NCSACW). 

Background 
NCSACW is funded by CB to partner to provide individuals and agencies 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 individuals to identify their needs and request NCSACW TA, followed by timely and responsive communication by NCSACW is critical for individuals and agencies to easily access necessary resources and TA. 

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 TA request form is to inform NCSACW of an individual or agency’s interest in engagement and the TA it is seeking, and to inform CB of the needs of agencies. The information collected will enable NCSACW to initiate engagement and collaborate to align TA with identified needs. 

Aggregate data will be summarized and reported on a bi-annual and annual basis to inform NCSACW and CB leadership of emerging needs, trends, and requests across agencies. 

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. 

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 NCSACW 
    • Planning for provision of programmatic T/TA through NCSACW 

Processes for Information Collection 
Data will be collected through NCSACW’s website. Individuals may volunteer to click the link to request TA and complete the TA 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 NCSACW platform and made accessible to authorized NCSACW staff. NCSACW will then initiate a conversation with the requestor to gather additional information and collaboratively determine and implement next steps. 

A3. Improved Information Technology to Reduce Burden
NCSACW’s platform streamlines the TA request process by providing requestors with the ability to complete and submit their requests electronically via a secure link in 4 minutes or less and receive a targeted, follow-up response within 1 business day.

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

A5. Involvement of Small Organizations
This request is designed to be least burdensome for all respondents and can be completed as needed. 

A6. Consequences of Less Frequent Data Collection
Data will be collected when an individual or agency would like to request information, TA, 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 NCSACW to connect and engage and for information, TA, 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 NCSACW to identify service requests and inform what NCSACW resources and TA are needed, that their participation is voluntary, and that their information will be kept private and accessible only to NCSACW 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 4 minutes per response, with an estimated 300 respondents per year. 

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 2025, which is $42.73 per hour. To account for fringe benefits and overhead, the rate was multiplied by two which is $85.46 per hour.

Instrument
Annual Number of Respondents
Total Number of Responses Per Respondent
Average Burden Hours Per Response
Annual
Burden Hours
Average Hourly Wage
Total Annual Cost
Technical assistance request form
300
1
0.066
20
$85.46
$1,709.20

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 $1,400. 

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 individuals to submit requests for information, resources, or TA from NCSACW. 

Data will be tabulated monthly and submitted in NCSACW’s bi-annual and annual progress reports to CB. Data may also be used in work plans when TA 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_NCSACW Technical Assistance Request Form