Approved
consistent with HHS' memos of 4/16/99 and 4/20/99. In addition, the
following terms apply: (1) HHS will make every effort to modify the
background information form (BIF) in those circumstances where
burden can be minimized due to duplication between the BIF and
information collected by the TANF agency and/or WtW data used for
intake and reporting purposes. In assessing whether or not to
modify the BIF, HHS will ensure that burden on respondents is
minimized. (2) In order to minimize burden on respondents HHS will
make the following changes to the forms: (a) limit information that
is repeated on both the BIF and the contact information form (CIF)
to only those data elements necessary for identification purposes.
Thus, HHS will limit the repeated information to name and SSN only,
(b) reduce the amount of *relative and friends* contacts requested
on the CIF from four to three. (3) HHS will, following the
completion of the selection of impact sites, but not later than
12/31/99, resubmit for OMB review, a revised table on *Minimal
Detectable Impacts* (see Table 4 on page 21 of the supporting
statement) that reflects the actual sample sizes achieved by HHS.
(4) HHS will collect, at baseline, information on whether the
individual requires substance abuse treatment. HHS, in order to
minimize burden, will first attempt to collect this information
from intake records, and if the intake records do not provide
sufficient information on this issue, through a revision to the
BIF.
Inventory as of this Action
Requested
Previously Approved
04/30/2002
04/30/2002
10,000
0
0
1,245
0
0
0
0
0
These data collection forms will allow
for the collection of baseline information on all those enrolled in
the analysis sample for the impact study component of the
evaluation. The baseline data is critical to understanding the
impacts of WtW services and will support later follow-up surveys of
the impact study sample.
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:
(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;
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.
Baseline Data Collection Forms for the Multi-Site Evaluation of the Welfare-to-Work Grants Program