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Refugee Support Services Refugee Health Promotion Set-Aside Programs Assessment Guide
Formative Data Collections for ACF Program Support
OMB: 0970-0531
IC ID: 270267
OMB.report
HHS/ACF
OMB 0970-0531
ICR 202409-0970-014
IC 270267
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0531 can be found here:
2024-11-12 - No material or nonsubstantive change to a currently approved collection
2024-10-04 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
QUEST_RHP SRHC Interview.docx
Other-Interview
QUEST_RHP SRHC Interview.docx
Other-Interview
QUEST_RHP Client Questionnaire.docx
Other-Questionnaire
QUEST_RHP Client Questionnaire.docx
Other-Questionnaire
QUEST_RHP Local Provider Guide.docx
Other-Focus Group Protocol
QUEST_RHP Local Provider Guide.docx
Other-Focus Group Protocol
SSA_RSS Set Asides Assessment_Formative Prog Support_RHP_8.20.2024_updated.docx
SSA - Refugee Support Services Refugee Health Promotion Set-Aside Programs Assessment Guides
IC Document
SSA_RSS Set Asides Assessment_Formative Prog Support_RHP_8.20.2024_updated.docx
SSA - Refugee Support Services Refugee Health Promotion Set-Aside Programs Assessment Guides
IC Document
Letter_RHP Client Invitation and Consent_ENGLISH.docx
Consent Form - RSS RHP Set-Aside Programs Assessment Guide
IC Document
Letter_RHP Client Invitation and Consent_ENGLISH.docx
Consent Form - RSS RHP Set-Aside Programs Assessment Guide
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Refugee Support Services Refugee Health Promotion Set-Aside Programs Assessment Guide
Agency IC Tracking Number:
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Interview
QUEST_RHP SRHC Interview.docx
Yes
Yes
Printable Only
Other-Questionnaire
QUEST_RHP Client Questionnaire.docx
Yes
Yes
Printable Only
Other-Focus Group Protocol
QUEST_RHP Local Provider Guide.docx
Yes
Yes
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
85
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
85
0
0
0
0
85
Annual IC Time Burden (Hours)
85
0
0
0
0
85
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA - Refugee Support Services Refugee Health Promotion Set-Aside Programs Assessment Guides
SSA_RSS Set Asides Assessment_Formative Prog Support_RHP_8.20.2024_updated.docx
08/20/2024
Consent Form - RSS RHP Set-Aside Programs Assessment Guide
Letter_RHP Client Invitation and Consent_ENGLISH.docx
08/20/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.