Office of Community Services Affordable Housing and Supportive Services Demonstration Data Collection

Forms and Documents

Document Name	Status
NonSub Change - Update to ACF ICs - Protecting Women EO - Submission 2.10.25.docx Justification for No Material/Nonsubstantive Change	2025-02-10
NonSub Change Request - AHSSD.docx Justification for No Material/Nonsubstantive Change	2025-01-07
Attachment E - Study Information Sheet for Individuals Completing Matrix.docx Supplementary Document	2024-08-28
Attachment D - Self Sufficiency Matrix Instructions & Consent.docx Supplementary Document	2024-08-28
Attachment C - Interview Consent Form CLEAN.docx Supplementary Document	2025-01-07
Attachment B - Invitation to Interview CLEAN.docx Supplementary Document	2025-01-07
Attachment A - Research Questions.docx Supplementary Document	2024-08-28
Supporting Statement B - AHSSD Revision (CLEAN).docx Supporting Statement B	2025-02-10
Supporting Statement A - AHSSD Revision (CLEAN).docx Supporting Statement A	2025-02-10

IC Document Collections

IC ID	Document Title	Status
270496	2024 Version – Semi-Annual Quantitative Report OPTIONAL Other-Semi Annual Report	Unchanged
270495	2024 Version – Semi-Annual Quantitative Report MANDATORY Other-Semi Annual Report	Modified
264807	Interviews with Caseworkers Other-Interview	Unchanged
264806	Interviews with Program Directors Other-Interview	Unchanged
264805	2023 Version – Semi-Annual Quantitative Report OPTIONAL Other-Semi Annual Report	Unchanged
264804	2023 Version – Semi-Annual Quantitative Report MANDATORY Other-Semi Annual Report	Modified
264803	Quarterly PPR Collections Other-Quarterly PPR	Modified
264802	Resident Interview Other-Interview	Unchanged
264801	Service Receipt Questionnaire Other-Questionnaire	Unchanged
264800	Self-Sufficiency Matrix Other-Questionnaire	Unchanged

ICR Details

OMB Control No: 0970-0628	ICR Reference No: 202502-0970-016
Status: Received in OIRA	Previous ICR Reference No: 202501-0970-001
Agency/Subagency: HHS/ACF	Agency Tracking No: OCS
Title: Office of Community Services Affordable Housing and Supportive Services Demonstration Data Collection
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/15/2025

	Requested	Previously Approved
Expiration Date	10/31/2027	10/31/2027
Responses	1,462	1,462
Time Burden (Hours)	1,393	1,393
Cost Burden (Dollars)	0	0

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Abstract: The Affordable Housing and Supportive Services Demonstration (AHSSD) Data Collection (OMB #0970-0628) was originally approved in March 2024 and then revised in September 2024. The information collection includes individual-level survey instruments and on-site focus groups to collect information from program participants, onsite and virtual interviews to collect information from program staff, and report forms to capture service delivery and outcomes. ACF has implemented changes to remove language related to DEI and update gender collected data to denote sex as a biological variable in current approved information collection requests to comply with the recent presidential directives.

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Authorizing Statute(s): US Code: 42 USC 1310 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 49878	06/12/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 71371	09/03/2024
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 10

IC Title	Form No.	Form Name
2023 Version – Semi-Annual Quantitative Report MANDATORY
2023 Version – Semi-Annual Quantitative Report OPTIONAL
2024 Version – Semi-Annual Quantitative Report MANDATORY
2024 Version – Semi-Annual Quantitative Report OPTIONAL
Interviews with Caseworkers
Interviews with Program Directors
Quarterly PPR Collections
Resident Interview
Self-Sufficiency Matrix
Service Receipt Questionnaire

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,462	1,462	0	0	0	0
Annual Time Burden (Hours)	1,393	1,393	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $43,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/15/2025

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