Prenatal Alcohol and Other Drugs Exposures in Child Welfare (PAODE-CW) Study

Forms and Documents

Document Name	Status
Form 1 Focus Group of Caregivers Form and Instruction	New
Form 1 Survey Instrument for Service Providers Form and Instruction	New
Form 1 Survey Instrument for Local Agency Staff-Form B Differential Response Form and Instruction	New
Form 1 Survey Instrument for Local Agency Staff-Form B General Form and Instruction	New
Form 1 Survey Instrument for Local Agency Staff-Form A General Form and Instruction	New
Form 1 Interview Protocol for Local Agency Staff-Frontline and Ongoing Form and Instruction	New
Form 1 Inteerview Protocol for Local Agency Staff-Ongoing Only Form and Instruction	New
Form 1 Interview Protocol for Local Agency Staff-Frontline Only Form and Instruction	New
Form 1 Interview Protocol for Local Agency Medical Staff Form and Instruction	New
Form 1 Interview Protocol for Data Staff Form and Instruction	New
Form 1 Interview Protocol for Local Agency Director Form and Instruction	New
Attachment 12 - PAODE_OMB Cost Burden Estimates Final.xlsx Supplementary Document	2018-05-22
Part B Supporting Statement-PAODE Final.docx Supporting Statement B	2018-05-22
Part A Supporting Statement-PAODE Final.docx Supporting Statement A	2018-05-22

IC Document Collections

IC ID	Document Title	Status
229650	Focus Group of Caregivers Form and Instruction	New
229649	Survey Instrument for Service Providers Form and Instruction	New
229648	Survey Instrument for Local Agency Staff-Form B Differential Response Form and Instruction	New
229647	Survey Instrument for Local Agency Staff-Form B General Form and Instruction	New
229646	Survey Instrument for Local Agency Staff-Form A General Form and Instruction	New
229645	Interview Protocol for Local Agency Staff-Frontline and Ongoing Form and Instruction	New
229644	Inteerview Protocol for Local Agency Staff-Ongoing Only Form and Instruction	New
229643	Interview Protocol for Local Agency Staff-Frontline Only Form and Instruction	New
229642	Interview Protocol for Local Agency Medical Staff Form and Instruction	New
229641	Interview Protocol for Data Staff Form and Instruction	New
229640	Interview Protocol for Local Agency Director Form and Instruction	New

ICR Details

OMB Control No: 0970-0511	ICR Reference No: 201801-0970-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Prenatal Alcohol and Other Drugs Exposures in Child Welfare (PAODE-CW) Study
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: 05/29/2018
	Date Received in OIRA: 01/08/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2021	36 Months From Approved
Responses	429	0	0
Time Burden (Hours)	306	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Administration for Children and Families (ACF), U.S. Department of Health and Human Services (HHS) is proposing a data collection activity as part of the Prenatal Alcohol and Other Drug Exposures in Child Welfare (PAODE–CW) Study. The study examines the current state of child welfare practice regarding the identification and provision of services for children with prenatal substance exposures, including alcohol and other drugs. The descriptive study will document the policies and practices of child welfare agencies and related organizations to identify, assess, and refer to services children who may have been exposed to prenatal substances and/or diagnosed with a resulting condition such as fetal alcohol spectrum disorders (FASD). The study will document procedures as well as challenges faced and lessons learned to inform the field of practice as well as policy makers, program administrators, and funders at various levels. The proposed information collection activities consist of semi-structured interviews and surveys conducted at 28 child welfare agency sites. Focus groups conducted at 8 of the 28 sites will gather information on needs, challenges, and strategies to support children with prenatal substance exposures and their families within the child welfare system.

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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:
	82 FR 48818	10/20/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 60746	12/22/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 11

IC Title	Form No.	Form Name
Survey Instrument for Local Agency Staff-Form B Differential Response	1	Survey Instrument for Local Agency Staff-Form B Diff
Interview Protocol for Data Staff	1	Interview Prorocol for Data Staff
Interview Protocol for Local Agency Medical Staff	1	Interview Protocol for Local Agency Medical Staff
Survey Instrument for Local Agency Staff-Form A General	1	Survey Instrument for Local Agency Staff
Survey Instrument for Local Agency Staff-Form B General	1	Survey Instrument for Local Agency Staff
Focus Group of Caregivers	1	Focus Group of Caregivers
Survey Instrument for Service Providers	1	Survey Instrument for Service Providers
Interview Protocol for Local Agency Director	1, 1	Interview Protocol for Local Agency Director
Inteerview Protocol for Local Agency Staff-Ongoing Only	1	Interview Protocol for Local Agency Staff Ongoing Only
Interview Protocol for Local Agency Staff-Frontline and Ongoing	1	Interview Protocol for Local Agency Staff-F&O
Interview Protocol for Local Agency Staff-Frontline Only	1	Interview Protocol for Local Agency Staff Frontline Only

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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	429	0	0	429	0	0
Annual Time Burden (Hours)	306	0	0	306	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: $165,452

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 01/08/2018

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