Instrument 14 Randomization Tool

OMB Control # 0970 – 0514

Expiration Date: 09/31/2021

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OMB Control # 0970 – 0514

Expiration Date: 09/31/2021

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OMB Control # 0970 – 0514

Expiration Date: 09/31/2021

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Project ID	Child Welfare ID	Child Welfare Status	Date Entered	Entered By	Site	Group Assignment	Form Received

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OMB Control # 0970 – 0514

Expiration Date: 09/31/2021

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The Paperwork Reduction Act Statement: This collection of information is voluntary and will be used to evaluate the effectiveness of the Family Unification Program.^[3] Public reporting burden for this collection of information is estimated to average 1 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. 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 number and expiration date for this collection are OMB #: 0970-0514, Exp: XX/XX/XXXX. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Michael Pergamit at mpergamit@urban.org.

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Instructions: This information is also being collected to inform the evaluation of the Family Unification Program (FUP) being conducted by a research team at the Urban Institute, Chapin Hall at the University of Chicago and Child Trends. The data to be collected are only project ID, child welfare ID and child welfare status. This information will not be shared outside of [REFERRING AGENCY], the child welfare agency, the public housing authority, and the research team.