Regional Partnership Grants National Cross-Site Evaluation and Evaluation Technical Assistance

Forms and Documents

Document Name	Status
Form VIIB Household Ros Data entry for comparison study sites - Government Form and Instruction	New
Form VIIB Household Ros Data entry for comparison study sites - Private sector Form and Instruction	New
Form VIB Household Rost Report Administrative data - Government Form and Instruction	New
Form VIB Household Rost Report administrative data - Private Sector Form and Instruction	New
Form VA Partner Survey Partner Survey - Government Form and Instruction	New
Form VA Partner Survey Partner Survey - Private Sector Form and Instruction	New
Form IVA Staff Survey Staff Survey - Government Form	New
Form IVA Staff Survey Staff Survey - Private Sector Form	New
Form IIB Description of Semi-annual progress reports - Government Form and Instruction	New
Form IIA Semi-Annual Pr Semi-annual progress reports - Private Sector Form and Instruction	New
Form IA Interview Topic Program Director Individual Interview - Government Form and Instruction	New
Form IA Interview Topic Program Director Individual Interview - Private Sector Form and Instruction	New
Part_B.docx Supporting Statement B	2013-12-20
VIII Copy of legislation.pdf Supplementary Document	2013-12-20
VIIA Standardized Instruments.pdf Supplementary Document	2013-12-09
VIIC Administrative Data Elements.pdf Supplementary Document	2013-12-09
VIIA Standardized Instruments.pdf Supplementary Document	2013-12-09
VIIC Administrative Data Elements.pdf Supplementary Document	2013-12-09
VIA Standardized Instruments.pdf Supplementary Document	2013-12-09
VIC Administrative Data Elements.pdf Supplementary Document	2013-12-09
VIA Standardized Instruments.pdf Supplementary Document	2013-12-09
VIC Administrative Data Elements.pdf Supplementary Document	2013-12-09
VIC Administrative Data Elements.pdf Supplementary Document	2013-12-09
VIC Administrative Data Elements.pdf Supplementary Document	2013-12-09
VH Partner Survey Thank-You Email.pdf Supplementary Document	2013-12-09
VG Partner Survey Grantee Reminder Request.pdf Supplementary Document	2013-12-09
VF Partner Survey Final Reminder Email.pdf Supplementary Document	2013-12-09
VE Partner Survey Reminder Email.pdf Supplementary Document	2013-12-09
VD Partner Survey Email Invitation.pdf Supplementary Document	2013-12-09
VC Partner Survey Advance Email.pdf Supplementary Document	2013-12-09
VB Partner Survey FAQ.pdf Supplementary Document	2013-12-09
VH Partner Survey Thank-You Email.pdf Supplementary Document	2013-12-09
VG Partner Survey Grantee Reminder Request.pdf Supplementary Document	2013-12-09
VF Partner Survey Final Reminder Email.pdf Supplementary Document	2013-12-09
VE Partner Survey Reminder Email.pdf Supplementary Document	2013-12-09
VD Partner Survey Email Invitation.pdf Supplementary Document	2013-12-09
VC Partner Survey Advance Email.pdf Supplementary Document	2013-12-09
VB Partner Survey FAQ.pdf Supplementary Document	2013-12-09
IVG Staff Survey Grantee Reminder Request.pdf Supplementary Document	2013-12-09
IVF Staff Survey Final Reminder Email.pdf Supplementary Document	2013-12-09
IVE Staff Survey Reminder Email.pdf Supplementary Document	2013-12-09
IVC Staff Survey Advance Email.pdf Supplementary Document	2013-12-09
IVB Staff Survey FAQ.pdf Supplementary Document	2013-12-09
IVD Staff Survey Email Invitation.pdf Supplementary Document	2013-12-09
IVG Staff Survey Grantee Reminder Request.pdf Supplementary Document	2013-12-09
IVF Staff Survey Final Reminder Email.pdf Supplementary Document	2013-12-09
IVE Staff Survey Reminder Email.pdf Supplementary Document	2013-12-09
IVC Staff Survey Advance Email.pdf Supplementary Document	2013-12-09
IVB Staff Survey FAQ.pdf Supplementary Document	2013-12-09
IVD Staff Survey Email Invitation.pdf Supplementary Document	2013-12-09
III Enrollment and Service Log Data Dictionary_rev copy.pdf Supplementary Document	2013-12-09
III Enrollment and Service Log Data Dictionary_rev copy.pdf Supplementary Document	2013-12-09
III Enrollment and Service Log Data Dictionary_rev copy.pdf Supplementary Document	2013-12-09
III Enrollment and Service Log Data Dictionary_rev copy.pdf Supplementary Document	2013-12-09
IB Site Visit Informant Form.pdf Supplementary Document	2013-12-06
Part_A revised 12-3-13 clean.docx Supporting Statement A	2013-12-20

IC Document Collections

IC ID	Document Title	Status
209841	Data entry for comparison study sites - Government Form and Instruction	New
209840	Data entry for comparison study sites - Private sector Form and Instruction	New
209839	Review records and submit data electronically - Government	New
209838	Review records and submit data electronically - Private Sector	New
209837	Enter data into local databases - Government	New
209836	Enter data into local databases - Private Sector	New
209835	Review and adopt reporting templates - Government	New
209834	Review and adopt reporting templates - Private Sector	New
209833	Report Administrative data - Government Form and Instruction	New
209832	Report administrative data - Private Sector Form and Instruction	New
209831	Obtain access to administrative data - Government	New
209830	Obtain Access to Administrative Data - Private Sector	New
209829	Partner Survey - Government Form and Instruction	New
209828	Partner Survey - Private Sector Form and Instruction	New
209827	Staff Survey - Government Form	New
209826	Staff Survey - Private Sector Form	New
209825	Service Log Entries - Government	New
209824	Service log entries - Private Sector	New
209823	Case Enrollment Data - Government	New
209822	Case enrollment data - Private Sector	New
209821	Semi-annual progress reports - Government Form and Instruction	New
209820	Semi-annual progress reports - Private Sector Form and Instruction	New
209819	Frontline staff individual interview - Government Other-Interview Topic Guide	New
209818	Frontline staff individual interview - Private sector Other-Interview Topic Guide	New
209817	Program manger/supervisor individual interview - Government Other-Interview Topic Guide	New
209816	Program manger/supervisor individual interview - Private Sector Other-Interview Topic Guide	New
209815	Program manager/supervisor group interview - Government Other-Interview Topic Guide	New
209814	Program Manager/Supervisor Group Interview - Private Sector Other-Interview Topic Guide	New
209813	Program Director Individual Interview - Government Form and Instruction	New
209812	Program Director Individual Interview - Private Sector Form and Instruction	New

ICR Details

OMB Control No: 0970-0444	ICR Reference No: 201312-0970-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No: 21073
Title: Regional Partnership Grants National Cross-Site Evaluation and Evaluation Technical Assistance
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/18/2014
	Date Received in OIRA: 12/20/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved
Responses	81,968	0	0
Time Burden (Hours)	18,860	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Children's Bureau seeks approval to collect information for the Regional Partnership Grants to Increase the Well-being of and Improve Permanency Outcomes for Children Affected by Substance Abuse (i.e., Regional Partnership Grants Program or "RPG") Cross-Site Evaluation and Evaluation-Related Technical Assistance project (the "RPG Cross-Site Evaluation"). The overall objective of the RPG Cross-Site Evaluation is to plan, develop, and implement a rigorous national cross-site evaluation of the RPG Grant Program, provide legislatively-mandated performance measurement, and furnish evaluation-related technical assistance to the grantees to improve the quality and rigor of their local evaluations. The project will document the programs and activities conducted through the RPG program and assess the extent to which the grants have been successful in addressing the needs of families with substance abuse problems who come to the attention of the child welfare system.

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Authorizing Statute(s): PL: Pub.L. 112 - 34 437 Name of Law: Child and Family Services Improvement Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 57641	09/19/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 72679	12/03/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 30

IC Title	Form No.	Form Name
Program Director Individual Interview - Private Sector	IA Interview Topic Guide, IB Site Visit Informant Form	IA Interview Topic Guide ,   IB Site Visit Informant Form
Program Director Individual Interview - Government	IA Interview Topic Guide	IA Interview Topic Guide
Program Manager/Supervisor Group Interview - Private Sector	IB Site Visit Informant Form	IB Site Visit Informant Form
Program manager/supervisor group interview - Government	IB Site Visit Informant Form	IB Site Visit Informant Form
Program manger/supervisor individual interview - Private Sector	IB Site Visit Informant Form	IB Site Visit Informant Form
Program manger/supervisor individual interview - Government	IB Site Visit Informant Form	IB Site Visit Informant Form
Frontline staff individual interview - Private sector	IB Site Visit Informant Form	IB Site Visit Informant Form
Frontline staff individual interview - Government	IB Site Visit Informant Form	IB Site Visit Informant Form
Semi-annual progress reports - Private Sector	IIA Semi-Annual Progress Report Form, IIB Description of Evidence-Based Practices, IIC Description of Other Services and Activities, IID Description of Partnerships, IIE Adherence Form	IIA Semi-Annual Progress Report Form ,   IIB Description of Evidence-Based Practices ,   IIC Description of Other Services and Activities ,   IID Description of Partnerships ,   IIE Adherence Form
Semi-annual progress reports - Government	IIB Description of Evidence-Based Practices, IIA Semi-Annual Progress Report Form, IIC Description of Other Services and Activities, IID Description of Partnerships, IIE Adherence Form	IIB Description of Evidence-Based Practices ,   IIA Semi-Annual Progress Report Form ,   IIC Description of Other Services and Activities ,   IID Description of Partnerships ,   IIE Adherence Form
Enter data into local databases - Private Sector
Enter data into local databases - Government
Review records and submit data electronically - Private Sector
Review records and submit data electronically - Government
Data entry for comparison study sites - Private sector	VIIB Household Roster	VIIB Household Roster
Data entry for comparison study sites - Government	VIIB Household Roster	VIIB Household Roster
Case enrollment data - Private Sector
Case Enrollment Data - Government
Service log entries - Private Sector
Service Log Entries - Government
Staff Survey - Private Sector	IVA Staff Survey	IVA Staff Survey
Staff Survey - Government	IVA Staff Survey	IVA Staff Survey
Partner Survey - Private Sector	VA Partner Survey	VA Partner Survey
Partner Survey - Government	VA Partner Survey	VA Partner Survey
Obtain Access to Administrative Data - Private Sector
Obtain access to administrative data - Government
Report administrative data - Private Sector	VIB Household Roster	VIB Household Roster
Report Administrative data - Government	VIB Household Roster	VIB Household Roster
Review and adopt reporting templates - Private Sector
Review and adopt reporting templates - Government

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	81,968	0	0	81,968	0	0
Annual Time Burden (Hours)	18,860	0	0	18,860	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

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Annual Cost to Federal Government: $1,157,654

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/20/2013

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