OMB control number

Program Impact Evaluations (Level 3 Evaluations)

OMB 1190-0021 · DOJ/CRT.

OMB 1190-0021

Over the next three years, CRS anticipates collecting program impact evaluation data for reassessing ongoing programs across several areas within community outreach. The purpose of these collections is to gather feedback from participants who attended CRS programs and to use that information to measure the impact of the programs. This work may entail redesigning and/or modifying existing programs based upon received feedback. CRS envisions using surveys, interviews, and other electronic data collection instruments.

The latest form for Program Impact Evaluations (Level 3 Evaluations) expires 2028-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 1190-0021 Facilitator Interview Form and Instruction
Form 1190-0021 Facilitator Interview Form and Instruction
Form 1190-0021 Fidelity Log Form and Instruction
Form 1190-0021 Fidelity Log Form and Instruction
Form 1190-0021 Council Interview Form and Instruction
Form 1190-0021 Council Interview Form and Instruction
Form 1190-0021 Participant Surveyt Form and Instruction
Form 1190-0021 Participant Interview Form and Instruction
Form 1190-0021 Participant Survey Form and Instruction
Form 1190-0021 Participant Survey Form and Instruction
1190_0021_CRS_L3_Non substantive change justification_Jan 2025.docx Justification for No Material/Nonsubstantive Change
1190_0021_CRS_L3_Non substantive change justification_Jan 2025.docx Justification for No Material/Nonsubstantive Change
1190-0021_CRS_L3_Supporting Statement Part A_updated burden_Feb.2025.docx Supplementary Document
1190-0021_CRS_Supporting Statement Part A 2024.docx Supporting Statement A
1190-0021_CRS_Supporting Statement Part A 2024.docx Supporting Statement A
Facilitator Interview Form and Instruction
Facilitator Interview Form and Instruction
Fidelity Log Form and Instruction
Fidelity Log Form and Instruction
Council Interview Form and Instruction
Council Interview Form and Instruction
Participant Interview Form and Instruction
Participant Interview Form and Instruction
Participant Survey Form and Instruction
Participant Survey Form and Instruction
L3 Evaluations Interview Other-Interview
L3 Evaluations Other-case study template

All Historical Document Collections

202504-1190-001	No material or nonsubstantive change to a currently approved collection	2025-04-28
202402-1190-001	Revision of a currently approved collection	2024-02-29
202007-1190-001 Approved with change	New collection (Request for a new OMB Control Number)	2020-07-31

OMB Details

L3 Evaluations

Federal Enterprise Architecture: Community and Social Services - Community and Regional Development