Assessing Models of Coordinated Services for Low-Income Children and Their Families (AMCS)

INSTRUMENT 3

REQUEST FOR Organizational chart and STAFFING INFORMATION

T o: [DIRECTOR OF STATE/LOCAL APPROACH]

Subject: AMCS: Request for staffing information

Dear [DIRECTOR OF STATE/LOCAL APPROACH]:

We are delighted that you have agreed to participate in the Assessing Models of Coordinated Services for Low-Income Children and Their Families (AMCS) one-hour telephone interview on [SCHEDULED DATE]. To help us make the discussion as informative as possible, we are requesting two documents ahead of time:

• First, could you please send us an organizational chart for [STATE/LOCAL APPROACH NAME], if available? This will help us better understand your organizational structure so that we can tailor our telephone discussion. If you do not have an organizational chart, you do not need to create one.

• Second, please find attached a staffing information table we’d like you to complete before the interview. In this table, please list the individuals (between two and five staff members) that you plan to have join the call. Ideally, staff would represent both leadership and staff who are knowledge of the day-to-day operations of the coordinated services approach. This will help provide contextual information for us ahead of the interview.

Please return the completed staffing information table, as well as the organizational chart (if available), by [DATE]. We anticipate this will take 30 minutes to complete. Your participation is voluntary, and what share will be considered private to the extent provided by law. For your records, we have also attached the completed profile shared previously. Please reach out to us with any questions. We look forward to speaking with you soon!

Sincerely,

[NAME]

Paperwork Reduction Act Statement: The referenced collection of information is voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 0970-0356 and it expires 06/30/2021.

AMCS

Request for Staffing Information

INSTRUCTIONS:

We would like to know about the staff who will be joining the telephone interview. For each staff member who will participate, please list their name, their role, and the length of time they’ve worked with the coordinated services approach.

A	B	C
Staff Member Name	Staff Member Title/Role	Length of Time Worked with the Approach
1.
2.
3.
4.
5.

Paperwork Reduction Act Statement: The referenced collection of information is voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 0970-0151 and it expires XX/XX/XXXX.

Paperwork Reduction Act Statement: The referenced collection of information is voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 0970-0151 and it expires XX/XX/XXXX.

Paperwork Reduction Act Statement: The referenced collection of information is voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 0970-0151 and it expires XX/XX/XXXX.

Paperwork Reduction Act Statement: This collection of information is voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for the described collection is 0970-0356 and it expires 06/30/2021. The time required to complete this collection of information is estimated to average 30 minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the collection of information. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: Mathematica Policy Research, 1100 1st Street, NE, 12th Floor, Washington, DC 20002, Attention: Elizabeth Cavadel.