Evaluation of the Child Welfare Capacity Building Collaborative

Forms and Documents

Document Name	Status
Form 1 Annual Collaboration Survey Form and Instruction	New
Form 1 Leadership Interview Part II - Tribes Form and Instruction	New
Form 1 Leadership Interview - Tribes Form and Instruction	New
Form 1 Leadership Interview - CIPS Form and Instruction	New
Form 1 Leadership Interview - States and Territories Form and Instruction	New
Form 1 Center for Courts CQI Workshops Form and Instruction	New
Form 1 CIP Annual Meeting Survey Form and Instruction	New
Form 1 Center for States Brief Tailored Services Survey Form and Instruction	New
Form 1 Center for States Constituency Groups Survey Form and Instruction	New
Form 1 Center for States Intensive Projects Survey Form and Instruction	New
Form 1 Center for States Information and Referral Survey Form and Instruction	New
Form 1 Tribal Organizational Assessment Family Interview Form and Instruction	New
Form 1 Tribal Organizationall Assessment Community Member/Elder Form and Instruction	New
Form 1 Tribal Organizational Assessessment Community Provider Interview Form and Instruction	New
Form 1 Tribal Organizational Assessment Caseworker Interview Form and Instruction	New
Form 1 Center for Tribes Needs and Fit Exploration Tool Phase 2 Form and Instruction	New
Form 1 Center for Tribes Needs and Fit Exploration Tool Phase 1 Form and Instruction	New
Form 1 Center for Tribes Demographic Survey Form and Instruction	New
Form 1 Center for Tribes Contact Form Form and Instruction	New
Form 1 Assessment & Capacity Building Plan Satisfaction Survey Form and Instruction	New
Form 1 Webinars, Events, and In-Person Meetings Satisfaction Survey Form and Instruction	New
Form 1 Learning Experiences Survey (intensive) Form and Instruction	New
Form 1 Learning Experiences Satisfaction Survey (single) Form and Instruction	New
Form 1 Webpages and Products Satisfaction Survey Form and Instruction	New
Demographic survey template Reviewed_June_2016.docx Supplementary Document	2016-08-24
Part B-CAP-B SUPPORTING STATEMENT 2-26-16 .docx Supporting Statement B	2016-03-07
Part A-SUPPORTING STATEMENT FOR.docx Supporting Statement A	2016-03-07

IC Document Collections

IC ID	Document Title	Status
220284	Annual Collaboration Survey Form and Instruction	New
220283	Leadership Interview Part II - Tribes Form and Instruction	New
220282	Leadership Interview - Tribes Form and Instruction	New
220281	Leadership Interview - CIPS Form and Instruction	New
220280	Leadership Interview - States and Territories Form and Instruction	New
220279	Center for Courts CQI Workshops Form and Instruction	New
220278	CIP Annual Meeting Survey Form and Instruction	New
220277	Center for States Brief Tailored Services Survey Form and Instruction	New
220276	Center for States Constituency Groups Survey Form and Instruction	New
220275	Center for States Intensive Projects Survey Form and Instruction	New
220274	Center for States Information and Referral Survey Form and Instruction	New
220273	Tribal Organizational Assessment Family Interview Form and Instruction	New
220272	Tribal Organizationall Assessment Community Member/Elder Form and Instruction	New
220271	Tribal Organizational Assessessment Community Provider Interview Form and Instruction	New
220269	Tribal Organizational Assessment Caseworker Interview Form and Instruction	New
220268	Center for Tribes Needs and Fit Exploration Tool Phase 2 Form and Instruction	New
220267	Center for Tribes Needs and Fit Exploration Tool Phase 1 Form and Instruction	New
220266	Center for Tribes Demographic Survey Form and Instruction	New
220265	Center for Tribes Contact Form Form and Instruction	New
220264	Assessment & Capacity Building Plan Satisfaction Survey Form and Instruction	New
220263	Webinars, Events, and In-Person Meetings Satisfaction Survey Form and Instruction	New
220262	Learning Experiences Survey (intensive) Form and Instruction	New
220261	Learning Experiences Satisfaction Survey (single) Form and Instruction	New
220260	Webpages and Products Satisfaction Survey Form and Instruction	New

ICR Details

OMB Control No: 0970-0484	ICR Reference No: 201602-0970-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No: ACYF
Title: Evaluation of the Child Welfare Capacity Building Collaborative
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 with change	Conclusion Date: 08/30/2016
	Date Received in OIRA: 03/09/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	36 Months From Approved
Responses	11,258	0	0
Time Burden (Hours)	1,784	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Evaluation of the Child Welfare Capacity Building Collaborative is sponsored by the Children’s Bureau (CB) in the Administration on Children, Youth and Families (ACYF), Administration for Youth and Families (ACF), U.S. Department of Health and Human Services (DHHS) which seeks approval for the data collection instruments and procedures described herein. The proposed information collection is necessary to facilitate, track, monitor, and evaluate the activities of the Capacity Building Collaborative which includes three Federally funded centers (Center for States, Center for Tribes, and Center for Courts) that deliver national child welfare expertise and training and technical assistance services to State, Tribal, and Territorial public child welfare agencies and Court Improvement Programs (CIPs).

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Authorizing Statute(s): None

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 67407	11/02/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 10866	03/02/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 24

IC Title	Form No.	Form Name
Tribal Organizational Assessment Family Interview	1	Tribal Organizational Assessment Family Interview
Leadership Interview - States and Territories	1	Leadership Interview-States and Territories
Center for Courts CQI Workshops	1	Center for Courts CQI Workshops Survey
Webpages and Products Satisfaction Survey	1	Webpages and Products Satisfaction Survey
Center for Tribes Contact Form	1	Center for Tribes Demographic Survey
Center for Tribes Demographic Survey	1	Center for Tribes Demographic Survey
Tribal Organizationall Assessment Community Member/Elder	1	Tribal Organizational Assessment Community Member-Elder Interview
Center for States Brief Tailored Services Survey	1	Center for States Brief Tailored Services Survey
CIP Annual Meeting Survey	1	CIP Annual Meeting Survey
Learning Experiences Satisfaction Survey (single)	1	Learning Experiences Satisfaction Survey (single)
Center for Tribes Needs and Fit Exploration Tool Phase 2	1	Center for Tribes Needs and Fit Exploration Tool Phase 2
Leadership Interview - CIPS	1	Leadership Interview-CIPS
Leadership Interview Part II - Tribes	1	Leadership Interview Part II-Tribes
Annual Collaboration Survey	1	Annual Collaboration Survey
Assessment & Capacity Building Plan Satisfaction Survey	1	Assessment and Capacity Building Plan Satisfaction Survey
Center for Tribes Needs and Fit Exploration Tool Phase 1	1	Center for Tribes Needs and Fit Exploration Tool Phase 1
Tribal Organizational Assessment Caseworker Interview	1	Tribal Organizational Assessment Caseworker Interview
Tribal Organizational Assessessment Community Provider Interview	1	Tribal Organizational Assessment Community Provider Interview
Leadership Interview - Tribes	1	Leadership Interivew-Tribes
Learning Experiences Survey (intensive)	1	Learning Experiences Satisfaction Survey (inttensive)
Webinars, Events, and In-Person Meetings Satisfaction Survey	1	Webinars, Events, and In-Person Meetings Satisfaction Survey
Center for States Information and Referral Survey	1	Center for States Information and Referral Survey
Center for States Intensive Projects Survey	1	Center for States Intensive Projects Survey
Center for States Constituency Groups Survey	1	Center for States Constituency Groups Survey

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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	11,258	0	0	11,258	0	0
Annual Time Burden (Hours)	1,784	0	0	1,784	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: New ICR.

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Annual Cost to Federal Government: $140,848

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 03/09/2016

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