83-c

83c_Community Choice Demonstration_2528-0337_02202024.docx

The Community Choice Demonstration

83-c

OMB: 2528-0337

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Paperwork Reduction Act

Change Worksheet

Agency/Subagency:

U.S. Department of Housing and Urban Development


OMB Control Number:

2528-0337

Enter only items that change

Current Record

New Record**

Agency form number(s):

     

     

     

Annual reporting and keeping hour burden




Number of respondents

     

     


Total annual responses

     

     


Percent of these responses collected electronically

    %

    %


Total annual hours

     

     


Difference


     


Explanation of difference

Program change

Adjustment


     

     

Annual reporting and recordkeeping cost burden (in thousands of dollars)




Total annualized Capital/Startup costs

     

     


Total annual costs (O&M)

     

     


Total annualized cost requested

     

     


Difference


     


Explanation of difference

Program change

Adjustment


     

     

Other change: **

This submission includes a series of non-substantive changes to the instruments to be administered as part of the Community Choice Demonstration. The proposed changes to the instruments have been made in response to feedback from the research study team and with approval from the Institutional Review Board (IRB). Proposed edits have been made for the purposes of clarifying language to enhance participant comprehension and streamlining the interview process. We do not anticipate these revisions to affect either the annual reporting and recordkeeping hour burden or the annual reporting and recordkeeping cost burden for the data collection. Please see the second page for details on the proposed changes to each item.


Attachment: Proposed Edits to Instruments for the Community Choice Demonstration


Instrument

Summary of Revisions

Revised - Attachment B Head of Household Existing Voucher Holder Informed Consent

The Informed Consent forms for Community Choice Demonstration (CCD) Phase 1 participants - Head of Household Existing Voucher Holder, Head of Household Waitlist Family, and Other Adult Household Member - were edited with minimal changes for clarity.

Revised - Attachment C Head of Household Waitlist Family Informed Consent

Revised - Attachment D Other Adult Household Member Informed Consent

Revised - Attachment N Phase 2 HoH Existing Voucher Holders Informed Consent

The Informed Consent forms for Community Choice Demonstration (CCD) Phase 2 participants - Head of Household (HoH) Existing Voucher Holder, HoH Waitlist Families, and Other Adult Household Member - were edited with minimal changes for clarity.


Revised - Attachment O Phase 2 Head of Household Waitlist Families Informed Consent

Revised - Attachment P Phase 2 Other Adult Household Member Informed Consent

Attachment B.2_The Home Assessment_Follow-up Phone Call Script

The Home Assessment Follow-up Phone Call Script was revised with a few edits to streamline the interview scheduling process.

Attachment C_The Home Assessment_Consent

The Home Assessment Consent form was edited to include a couple of minimal changes to enhance participant comprehension.

Attachment D_The Home Assessment_Direct Measurements

The Home Assessment was edited to correct a clerical error regarding the threshold value of an environmental measure.

Attachment K.2_The Child Assessment and The Obesity & Type II Diabetes Risk Assessment_Follow-up Phone Call Script

The Child Assessment/Obesity & Type II Diabetes Risk Assessment Follow-up Phone Call Script was revised with a few edits to streamline the interview scheduling process.

Attachment L_The Child and MOVED Assessments_Consent

The Child and MOVED Assessment was modified with minimal plain language edits to improve clarity and participant comprehension.

Attachment M.1_The Obesity Type II Diabetes Risk Assessment_Survey_Baseline

The Obesity Type II Diabetes Risk Assessment Surveys - Baseline and Follow-up - were revised to include a question to refine collection of respondent health information. Minimal edits were also made to recapture information already reported (respondent email/address) to facilitate timely delivery of the incentive to the respondent. However, we do not expect these changes to substantively affect respondent burden.

Attachment M.2_The Obesity Type II Diabetes Risk Assessment_Survey_Follow-up

Attachment N_The Obesity & Type II Diabetes Risk Assessment_Anthropometric Assessments_Adult

The Obesity & Type II Diabetes Risk Assessment Anthropometric Assessments - Adult and Child - were revised with minimal edits to streamline interviewer instructions and ensure use of field-standard measurement practices.

Attachment O_The Obesity & Type II Diabetes Risk Assessment_Anthropometric Assessments_Child


Signature of Senior Official or Designee:





X

Date:

For OIRA Use




** This form cannot be used to extend an expiration date.

OMB 83-C 10/95

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File Created2024-10-26

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