State and Tribal Technical Assistance and Resources Training and Technical Assistance Roundtable Registration Form

OMB #: 0970-0617

Expiration Date: 09/30/2026

STAR TA Regional Meeting Registration Form

May 2024

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN:

The purpose of this information collection is to gather information from participants registering for Office of Family Assistance technical assistance meetings to help meeting organizers prepare appropriately for the meeting. Public reporting burden for this collection of information is estimated to average 4 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. An 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 0970-0617 and the expiration date is 09/30/2024. If you have any comments on this collection of information, please contact Lizeth Hester at Lizeth.hester@acf.hhs.gov.

Notes for Administration of Registration form: The below questions will be included in an online registration form for participants of OFA’s regional technical assistance meetings. Meeting organizers will use the information to prepare meeting logistics and content.

1. Prefix

Select one only (drop down menu)

 Mr. 1

 Mrs. 2

 Ms. 3

 Miss. 4

 Dr. 5

 Prof. 6

 Rev. 7

 Mx. 8

2. First name*

(STRING (NUM))

3. Last name*

(STRING (NUM))

4. Email address*

(STRING (NUM))

5. Job Title*

(STRING (NUM))

6. Organization*

(STRING (NUM))

7. State*

(STRING (NUM))

8. Are you staying at the [hotel name] hotel during the meeting?*

Select one only (drop down menu)

 Yes 1

 No. 0

Meeting participants will have the opportunity to engage in an open conversation with OFA leadership. To help OFA leadership prepare, please share the following:

9. What questions do you have related to TANF provisions in the Fiscal Responsibility Act of 2023 (FRA)? Please note, OFA may not have new information available to answer all questions at the time of the meeting.

(STRING (NUM))

10. What other questions do you have for OFA leadership? Use this space to share questions on any topic other than the FRA.

(STRING (NUM))

OFA leadership will answer as many questions as possible at the meeting. They will prioritize the most frequently asked questions.