Permanency Innovations Initiative - California Partnership for Permanency (CAPP)

Pre-testing of Evaluation Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0355 can be found here:

Documents and Forms

Document Name Document Type
A1. CAPP FAQ Parent-Guardian with Bill of Rights.docx Other-Consent
A2. CAPP Parent Study Contact Information Form.docx Other-Contact Info
A3. CAPP Parent-Guardian Interview with consent script.docx Other-Interview
Supporting Statement A_AZ CAPP IL generic_FINAL 1.1.13.docx PII - CAPP Supporting Statement A IC Document
Supporting Statement B_AZ CAPP IL generic_FINAL 1.1.13.docx PII - CAPP Supporting Statement B IC Document
PII - CAPP Increase in Burden Memo 10.7.14.KM.docx PII Nonsubstantive Change Request Memo IC Document

Information Collection (IC) Details

IC Title:	Permanency Innovations Initiative - California Partnership for Permanency (CAPP)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Consent	A1. CAPP FAQ Parent-Guardian with Bill of Rights.docx	Yes	Yes	Fillable Fileable
Other-Contact Info	A2. CAPP Parent Study Contact Information Form.docx	Yes	Yes	Fillable Fileable
Other-Interview	A3. CAPP Parent-Guardian Interview with consent script.docx	No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 49	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	49	49
Annual IC Time Burden (Hours)	22	22
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PII - CAPP Supporting Statement A	Supporting Statement A_AZ CAPP IL generic_FINAL 1.1.13.docx	01/08/2015
PII - CAPP Supporting Statement B	Supporting Statement B_AZ CAPP IL generic_FINAL 1.1.13.docx	01/08/2015
PII Nonsubstantive Change Request Memo	PII - CAPP Increase in Burden Memo 10.7.14.KM.docx	01/08/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.