Instrument 3. FCL Dissemination Pilot Survey
Through this information collection, ACF is gathering feedback on materials used for a dissemination pilot for the Fathers and Continuous Learning Project. Public reporting burden for this collection of information is estimated to average 10 minutes per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. The agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0401 and the expiration date is 06/30/2024. If you have any comments on this collection of information, please contact Jill Spielfogel at jspielfogel@mathematica-mpr.com.
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Please rate your agreement with the following statements:
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Strongly Agree |
Agree |
Neither agree nor disagree |
Disagree |
Strongly disagree |
Did not use or participate |
Site Self-Assessment |
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PDSA Worksheet |
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Collaborative Change Framework |
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Action Planning Form |
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Data collection planning worksheet |
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LADDERS Framework |
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Racial Justice Framework |
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Strongly Agree |
Agree |
Neither agree nor disagree |
Disagree |
Strongly disagree |
Did not use or participate |
Site Self-Assessment |
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PDSA Worksheet |
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Collaborative Change Framework |
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Action Planning Form |
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Data collection planning worksheet |
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LADDERS Framework |
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Racial Justice Framework |
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Strongly Agree |
Agree |
Neither agree nor disagree |
Disagree |
Strongly disagree |
Did not use or participate |
Site Self-Assessment |
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PDSA Worksheet |
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Collaborative Change Framework |
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Action Planning Form |
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Data collection planning worksheet |
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LADDERS Framework |
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Racial Justice Framework |
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Strongly Agree |
Agree |
Neither agree nor disagree |
Disagree |
Strongly disagree |
Did not use or participate |
Site Self-Assessment |
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Collaborative Change Framework |
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Racial Justice Framework |
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Strongly Agree |
Agree |
Neither agree nor disagree |
Disagree |
Strongly disagree |
Did not use or participate |
Site Self-Assessment |
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PDSA Worksheet |
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Collaborative Change Framework |
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Action Planning Form |
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Data collection planning worksheet |
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LADDERS Framework |
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Racial Justice Framework |
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Strongly Agree |
Agree |
Neither agree nor disagree |
Disagree |
Strongly disagree |
Did not use or participate |
Site Self-Assessment |
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PDSA Worksheet |
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Collaborative Change Framework |
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Action Planning Form |
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Data collection planning worksheet |
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LADDERS Framework |
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Racial Justice Framework |
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Open-ended response |
Site Self-Assessment |
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PDSA Worksheet |
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Collaborative Change Framework |
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Action Planning Form |
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Data collection planning worksheet |
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LADDERS Framework |
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Racial Justice Framework |
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Open-ended response |
Site Self-Assessment |
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PDSA Worksheet |
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Collaborative Change Framework |
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Action Planning Form |
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Data collection planning worksheet |
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LADDERS Framework |
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Racial Justice Framework |
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Open-ended response |
For FCL Dissemination Pilot. Do not distribute.
Mathematica®
Inc.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Mathematica Proposal |
Subject | proposal |
Author | Jill Spielfogel |
File Modified | 0000-00-00 |
File Created | 2024-07-22 |