OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Healthy Marriage and Responsible Fatherhood Local Evaluation Technical Assistance (HMRF-LETA)

IC 280976 under ICR 202611-0970-004 · OMB 0970-0531.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Instrument 1_HMRFLETA_Evaluation Plan Template_clean_v2.docx Other-Template
Instrument 2_HMRFLETA_Evaluation Benchmark Tracking Form_clean_v3.docx Other-Tracker
HMRFLETA_OMB_SSA Package Draft_v3_clean.docx
SSA - Prog Supp GenIC: HMRFLETA Evaluation TA		IC Document
Attachment A_HMRFLETA_Evaluation Plan Example Emails_clean_v2.docx
Attachment A: HMRFLETA Evaluation Plan Example Emails		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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-Template Yes Yes Fillable Fileable
Other-Tracker Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 800 0 0 0 0 800
Annual IC Time Burden (Hours) 484 0 0 0 0 484
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
SSA - Prog Supp GenIC: HMRFLETA Evaluation TA 06/15/2026
Attachment A: HMRFLETA Evaluation Plan Example Emails 06/15/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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