Subsidized and Transitional Employment Demonstration (STED) and Enhanced Transitional Jobs Demonstration (ETJD)

Forms and Documents

Document Name	Status
App Z Staff Script - Talking with Clients about the Paycheck Plus Study Final 6-26-15.docx Supplementary Document	2015-06-29
Appendix W3 PP Atlanta IRS Consent to Use Final 6-26-15.docx Supplementary Document	2015-06-29
Appendix W2 PP Atlanta IRS Consent to Disclose Final 06-26-15.docx Supplementary Document	2015-06-29
Appendix W1 Paycheck_Plus_ICF_Atlanta_Final 6-26-15.docx Supplementary Document	2015-06-29
Appendix T STED_ETJD 30 Month Overview.docx Supplementary Document	2014-05-06
STED-ETJD Supporting Statement Part B Final 6-26-15.docx Supporting Statement B	2015-06-29
STED Young Adult to Adult Survey Comparison May 2013.docx Supplementary Document	2013-05-13
Appendix_B.1_Informed Consent Revised May 2013 Final.docx Supplementary Document	2013-05-13
Appendix_J_Interview Guides_26APR12.doc Supplementary Document	2012-05-03
STED-ETJD Supporting Statement Part A Final 6-26-15.docx Supporting Statement A	2015-06-30

IC Document Collections

IC ID	Document Title	Status
217255	Appendix Y - Participant baseline information form (Paycheck Plus) Other-Survey	New
217254	Appendix X - Contact Information Form for Paycheck Plus site Other-Contact Info	New
211534	Appendix U Participant 30-month survey Other-Survey	Modified
207067	Participant 12-month survey (Young Adult sites) Other-Survey	Unchanged
207066	Participant 6-month survey (Young Adult sites) Other-Survey	Unchanged
202240	Program Staff Time-Use Worksheet Other-Staff-Use Worksheet	Unchanged
202239	Referral Partner Interview Guides Other-Referral Partners Interview Guides	Unchanged
202238	Employer Interview Guides Other-Employer Interview Guides	Unchanged
202237	Program Staff Cost Data Collection Protocol Other-Protocol	Unchanged
202236	Program Staff Interview Guides Other-Program Staff Interview Guides	Unchanged
202235	Employer Implementation Questionnaire Other-Employer Implementation Questionnaire	Unchanged
202234	Worksite Supervisor Implementation Questionnaire Other-Worksite Supervisor Implementation Questionnaire	Unchanged
202233	Program Staff Implementation Questionnaire Other-Program Staff Implementation Questionnaire	Unchanged
202232	Participant Focus Group Discussion Guide Other-Focus Group Guide	Unchanged
202231	Participant Implementation Questionnaire Other-Questionnaire	Unchanged
202230	Participant 12-month survey (Adult sites) Other-12 Month Follow-Up	Unchanged
202229	Participant 6-month survey (Adult sites) Other-6-month survey	Unchanged
202228	Participant ETJD tracking letters Other-Tracking Letters	Unchanged
202227	Participant STED tracking letters Other-Tracking Letters	Unchanged
202226	Participant Baseline Information Form Other-BIF	Modified
202225	Participant Contact Information Form Other-Contact Info Form	Modified

ICR Details

OMB Control No: 0970-0413	ICR Reference No: 201506-0970-017
Status: Historical Active	Previous ICR Reference No: 201405-0970-001
Agency/Subagency: HHS/ACF	Agency Tracking No: 19600
Title: Subsidized and Transitional Employment Demonstration (STED) and Enhanced Transitional Jobs Demonstration (ETJD)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/30/2015
	Date Received in OIRA: 07/09/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2017	36 Months From Approved	09/30/2017
Responses	27,009	0	22,475
Time Burden (Hours)	7,681	0	7,006
Cost Burden (Dollars)	0	0	0

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Abstract: This is a revision to the Subsidized and Transitional Employment Demonstration (STED) and Enhanced Transitional Jobs Demonstration (ETJD) information collection. This request includes a contact information form and a baseline form to be administered to study participants in a new STED site. As discussed below, these data collected for the new site will provide important demographic information about the study sample, help to ensure the comparability of the program and control groups, and allow for an analysis of program effects for selected subgroups.

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Authorizing Statute(s): PL: Pub.L. 74 - 271 413 Name of Law: Social Security Act; Research, Evaluations and National Studies
  

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:
	80 FR 13385	03/13/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 38208	07/02/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 21

IC Title	Form No.	Form Name
Program Staff Time-Use Worksheet
Participant 12-month survey (Young Adult sites)
Appendix U Participant 30-month survey
Appendix X - Contact Information Form for Paycheck Plus site
Worksite Supervisor Implementation Questionnaire
Employer Implementation Questionnaire
Program Staff Interview Guides
Program Staff Cost Data Collection Protocol
Employer Interview Guides
Referral Partner Interview Guides
Appendix Y - Participant baseline information form (Paycheck Plus)
Participant 6-month survey (Young Adult sites)
Participant Contact Information Form
Participant Baseline Information Form
Participant STED tracking letters
Participant ETJD tracking letters
Participant 6-month survey (Adult sites)
Participant 12-month survey (Adult sites)
Participant Implementation Questionnaire
Participant Focus Group Discussion Guide
Program Staff Implementation Questionnaire

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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	27,009	22,475	0	4,534	0	0
Annual Time Burden (Hours)	7,681	7,006	0	675	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 amendment includes additional data collection efforts, which include the contact information form and baseline form for the new STED site. We have also revised the number of respondents to two previously approved information collections, based on the status of the project.

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Annual Cost to Federal Government: $8,039,366

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: 07/09/2015

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