Family Level Assessment and State of Home Visiting (FLASH-V) - Formative Data Collection

Formative Data Collections for Policy Research and Evaluation

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0356 can be found here:

Documents and Forms

Document Name Document Type
1 - Eligibility Assessment Form.xlsm Other-Eligibility Assessment Form
2 - Outreach to LIAs and CIs, Assessing Eligibility, and Scheduling Interviews.docx Other-Outreach and Scheduling
3 - Interview Protocol_LIA.docx Other-Interview Protocol – LIA
4 - Interview Protocol_Centralized Intake Agency.docx Other-Interview Protocol – Centraliz
FLASH-V SSA Template - Formative Generics 010918.doc FLASH-V Formative Generic - Supporting Statement A IC Document
FLASH-V SSB Template - Formative Generics 010918.doc FLASH-V Formative Generic - Supporting Statement B IC Document
Appendix A - Outreach to State Grantees.docx Appendix A - Outreach to State Grantees IC Document
Appendix B - Project Description.docx Appendix B - Project Description IC Document
Appendix C - Informed Consent.docx Appendix C - Informed Consent IC Document

Information Collection (IC) Details

IC Title:	Family Level Assessment and State of Home Visiting (FLASH-V) - Formative Data Collection	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Eligibility Assessment Form	1 - Eligibility Assessment Form.xlsm	Yes	Yes	Fillable Fileable
Other-Outreach and Scheduling	2 - Outreach to LIAs and CIs, Assessing Eligibility, and Scheduling Interviews.docx	No		Paper Only
Other-Interview Protocol – LIA	3 - Interview Protocol_LIA.docx	No		Paper Only
Other-Interview Protocol – Centralized Intake Agency	4 - Interview Protocol_Centralized Intake Agency.docx	No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 118	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	118	118
Annual IC Time Burden (Hours)	57	57
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
FLASH-V Formative Generic - Supporting Statement A	FLASH-V SSA Template - Formative Generics 010918.doc	01/12/2018
FLASH-V Formative Generic - Supporting Statement B	FLASH-V SSB Template - Formative Generics 010918.doc	01/12/2018
Appendix A - Outreach to State Grantees	Appendix A - Outreach to State Grantees.docx	01/12/2018
Appendix B - Project Description	Appendix B - Project Description.docx	01/12/2018
Appendix C - Informed Consent	Appendix C - Informed Consent.docx	01/12/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.