Regional Partnership Grants National Cross-Site Evaluation and Evaluation Technical Assistance

Forms and Documents

Document Name	Status
Form 1 Data Entry for Comparision Study Sites Form and Instruction	New
Form 1 Review Records and Submit Electonically Form and Instruction	New
Form 1 Enter Data in Local Database Form and Instruction	New
Form 1 Report Administrative Data Form and Instruction	New
Form 1 Obtain Access to Administrative Data Form and Instruction	New
Form 1 Partner Survey Form and Instruction	New
Form 1 Staff Survey Form and Instruction	New
Form 1 Service Log Entries Form and Instruction	New
Form 1 Case Enrollment Data Form and Instruction	New
Form 1 Semi-Annual Progress Report Form and Instruction	New
Form 1 Frontline Staff Individual Interview Form and Instruction	New
Form 1 Program Manager/Supervisor Individual Interview Form and Instruction	New
Form 1 Program Manager/Supervisor Group Interview Form and Instruction	New
Form 1 Program Director Individual Interview Form and Instruction	New
Form VIIB Household Ros Data entry for comparison study sites - Government Form and Instruction	Removed
Form VIIB Household Ros Data entry for comparison study sites - Private sector Form and Instruction	Removed
Form VIB Household Rost Report Administrative data - Government Form and Instruction	Removed
Form VIB Household Rost Report administrative data - Private Sector Form and Instruction	Removed
Form VA Partner Survey Partner Survey - Government Form and Instruction	Removed
Form VA Partner Survey Partner Survey - Private Sector Form and Instruction	Removed
Form IVA Staff Survey Staff Survey - Government Form	Removed
Form IVA Staff Survey Staff Survey - Private Sector Form	Removed
Form IIB Description of Semi-annual progress reports - Government Form and Instruction	Removed
Form IIB Description of Semi-annual progress reports - Private Sector Form and Instruction	Removed
Form IA Interview Topic Program Director Individual Interview - Government Form and Instruction	Removed
Form IA Interview Topic Program Director Individual Interview - Private Sector Form and Instruction	Removed
supporting statement Part_A 12062016 (4).docx Supporting Statement A	2016-12-15
Part_B for OMB March 2020 renewal.docx Supporting Statement B	2016-12-07
VII Copy of legislation.pdf Supplementary Document	2016-12-07
IIF RPG3 Description of Other Services and Activities.docx Supplementary Document	2016-12-07
IIE RPG3 Description of Evidence-Based Practices.docx Supplementary Document	2016-12-07
IIC RPG2 Description of Other Services and Activities.docx Supplementary Document	2016-12-07
IIB RPG2 Description of Evidence-Based Practices.docx Supplementary Document	2016-12-07
IIA RPG2 Semi-Annual Progress Report Form.docx Supplementary Document	2016-12-07
RPG OMB references for OMB March 2020 renewal.docx Supplementary Document	2016-12-07

IC Document Collections

IC ID	Document Title	Status
224732	Data Entry for Comparision Study Sites Form and Instruction	New
224731	Review Records and Submit Electonically Form and Instruction	New
224730	Enter Data in Local Database Form and Instruction	New
224729	Report Administrative Data Form and Instruction	New
224728	Obtain Access to Administrative Data Form and Instruction	New
224727	Partner Survey Form and Instruction	New
224726	Staff Survey Form and Instruction	New
224725	Service Log Entries Form and Instruction	New
224724	Case Enrollment Data Form and Instruction	New
224723	Semi-Annual Progress Report Form and Instruction	New
224722	Frontline Staff Individual Interview Form and Instruction	New
224721	Program Manager/Supervisor Individual Interview Form and Instruction	New
224719	Program Manager/Supervisor Group Interview Form and Instruction	New
224718	Program Director Individual Interview Form and Instruction	New
209841	Data entry for comparison study sites - Government Form and Instruction	Removed
209840	Data entry for comparison study sites - Private sector Form and Instruction	Removed
209839	Review records and submit data electronically - Government	Removed
209838	Review records and submit data electronically - Private Sector	Removed
209837	Enter data into local databases - Government	Removed
209836	Enter data into local databases - Private Sector	Removed
209835	Review and adopt reporting templates - Government	Removed
209834	Review and adopt reporting templates - Private Sector	Removed
209833	Report Administrative data - Government Form and Instruction	Removed
209832	Report administrative data - Private Sector Form and Instruction	Removed
209831	Obtain access to administrative data - Government	Removed
209830	Obtain Access to Administrative Data - Private Sector	Removed
209829	Partner Survey - Government Form and Instruction	Removed
209828	Partner Survey - Private Sector Form and Instruction	Removed
209827	Staff Survey - Government Form	Removed
209826	Staff Survey - Private Sector Form	Removed
209825	Service Log Entries - Government	Removed
209824	Service log entries - Private Sector	Removed
209823	Case Enrollment Data - Government	Removed
209822	Case enrollment data - Private Sector	Removed
209821	Semi-annual progress reports - Government Form and Instruction	Removed
209820	Semi-annual progress reports - Private Sector Form and Instruction	Removed
209819	Frontline staff individual interview - Government Other-Interview Topic Guide	Removed
209818	Frontline staff individual interview - Private sector Other-Interview Topic Guide	Removed
209817	Program manger/supervisor individual interview - Government Other-Interview Topic Guide	Removed
209816	Program manger/supervisor individual interview - Private Sector Other-Interview Topic Guide	Removed
209815	Program manager/supervisor group interview - Government Other-Interview Topic Guide	Removed
209814	Program Manager/Supervisor Group Interview - Private Sector Other-Interview Topic Guide	Removed
209813	Program Director Individual Interview - Government Form and Instruction	Removed
209812	Program Director Individual Interview - Private Sector Form and Instruction	Removed

ICR Details

OMB Control No: 0970-0444	ICR Reference No: 201612-0970-002
Status: Historical Active	Previous ICR Reference No: 201502-0970-009
Agency/Subagency: HHS/ACF	Agency Tracking No: ACYF
Title: Regional Partnership Grants National Cross-Site Evaluation and Evaluation Technical Assistance
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/15/2017
	Date Received in OIRA: 12/19/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved	03/31/2017
Responses	305,623	0	100,814
Time Burden (Hours)	64,809	0	22,984
Cost Burden (Dollars)	0	0	0

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Abstract: Under RPG, CB has issued 21 grants (17 grants under RPG2 and 4 grants under RPG3) to organizations such as child welfare or substance use disorder treatment providers or family court systems to develop interagency collaborations and provide services designed to increase well-being, improve permanency, and enhance the safety of children who are in an out-of-home placement or are at risk of being placed in out-of-home care as a result of a parent’s or caretaker’s substance use disorder. CB required RPG grantees to use evidence-based or evidence-informed programs to deliver services to children, adults, and families. The overall objective of the RPG Cross-Site Evaluation is to plan, develop, and implement a rigorous national cross-site evaluation of the RPG Grant Program, provide legislatively-mandated performance measurement, and furnish evaluation-related technical assistance to the grantees to improve the quality and rigor of their local evaluations. The project will document the programs and activities conducted through the RPG program and assess the extent to which the grants have been successful in addressing the needs of families with substance use disorders who come to the attention of the child welfare system.

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Authorizing Statute(s): PL: Pub.L. 112 - 34 437 Name of Law: Child and Family Services Improvement 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:
	81 FR 41310	06/24/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 88688	12/08/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 14

IC Title	Form No.	Form Name
Program manger/supervisor individual interview - Private Sector	IB Site Visit Informant Form	IB Site Visit Informant Form
Semi-annual progress reports - Private Sector	IIA Semi-Annual Progress Report Form, IIB Description of Evidence-Based Practices, IIC Description of Other Services and Activities, IID Description of Partnerships, IIE Adherence Form	IIB Description of Evidence-Based Practices ,   IIC Description of Other Services and Activities ,   IID Description of Partnerships ,   IIE Adherence Form ,   IIA Semi-Annual Progress Report Form
Semi-annual progress reports - Government	IIB Description of Evidence-Based Practices, IIA Semi-Annual Progress Report Form, IIC Description of Other Services and Activities, IID Description of Partnerships, IIE Adherence Form	IIB Description of Evidence-Based Practices ,   IIA Semi-Annual Progress Report Form ,   IIC Description of Other Services and Activities ,   IID Description of Partnerships ,   IIE Adherence Form
Case enrollment data - Private Sector
Case Enrollment Data - Government
Staff Survey - Private Sector	IVA Staff Survey	IVA Staff Survey
Program Director Individual Interview - Government	IA Interview Topic Guide	IA Interview Topic Guide
Program manger/supervisor individual interview - Government	IB Site Visit Informant Form	IB Site Visit Informant Form
Report Administrative data - Government	VIB Household Roster	VIB Household Roster
Review and adopt reporting templates - Government
Review records and submit data electronically - Government
Data entry for comparison study sites - Private sector	VIIB Household Roster	VIIB Household Roster
Program Director Individual Interview	1	Interview Topic Guide
Semi-Annual Progress Report	1	RPG2 Semi-Annual Progress Report Form
Case Enrollment Data	1	Enrollment and Service Log Data Dictionary
Service Log Entries	1	III Enrollment and Service Log Data Dictrionary
Obtain Access to Administrative Data	1	Outcome and Impact Study Information System User Guide and Data Dictionary
Data Entry for Comparision Study Sites	1	Outcome and Impact Study Information System User Guide and Data Dictionary
Partner Survey - Government	VA Partner Survey	VA Partner Survey
Frontline staff individual interview - Private sector	IB Site Visit Informant Form	IB Site Visit Informant Form
Frontline staff individual interview - Government	IB Site Visit Informant Form	IB Site Visit Informant Form
Service log entries - Private Sector
Service Log Entries - Government
Staff Survey - Government	IVA Staff Survey	IVA Staff Survey
Report administrative data - Private Sector	VIB Household Roster	VIB Household Roster
Enter data into local databases - Government
Review records and submit data electronically - Private Sector
Data entry for comparison study sites - Government	VIIB Household Roster	VIIB Household Roster
Program Manager/Supervisor Group Interview	1	Interview Topic Guide
Program Manager/Supervisor Individual Interview	1	Interview Topic Guide
Frontline Staff Individual Interview	1	Interview Topic Guide
Staff Survey	1	Staff Survey
Partner Survey	1	Partner Survey
Program manager/supervisor group interview - Government	IB Site Visit Informant Form	IB Site Visit Informant Form
Enter data into local databases - Private Sector
Report Administrative Data	1	Outcome and Impact Study Information System User Guide and Data Dicstionary
Enter Data in Local Database	1	Outcome and Impact Study Information System User Guide and Data Dictionary
Review Records and Submit Electonically	1	Outcome and Impact Study Information System User Guide and Data Dictionary
Program Director Individual Interview - Private Sector	IA Interview Topic Guide, IB Site Visit Informant Form	IA Interview Topic Guide ,   IB Site Visit Informant Form
Partner Survey - Private Sector	VA Partner Survey	VA Partner Survey
Obtain Access to Administrative Data - Private Sector
Obtain access to administrative data - Government
Review and adopt reporting templates - Private Sector
Program Manager/Supervisor Group Interview - Private Sector	IB Site Visit Informant Form	IB Site Visit Informant Form

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ICR Summary of Burden

	Total Approved	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	305,623	100,814	0	305,623	-100,814	0
Annual Time Burden (Hours)	64,809	22,984	0	64,809	-22,984	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: For additional grants awarded.

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Annual Cost to Federal Government: $1,118,315

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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? Uncollected

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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: 12/19/2016

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