Eligibility Information From Applicants: Reviewer Information Form for General Reviewer and for Specific Reviewers (Previously approved, ongoing collection)

Generic Reviewer Recruitment Form

Fillable Reviewer Information Form for Specific Reviews wmd

Eligibility Information From Applicants: Reviewer Information Form for General Reviewer and for Specific Reviewers (Previously approved, ongoing collection)

OMB: 0970-0477

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OMB Control Number: 0970-0477

Expiration Date: 3/31/2019 Information Collection for Specific Reviews

Review Title(s):___[To be completed by contractor]__________________________________________

Dates of Review(s): ):___[To be completed by contractor]______________________________________

Please fill out the table below:

Name:      

Address During Review Dates:      

Time Zone During Review Dates:      

Home Phone:      

Office Phone:      

Cell Phone:      

Preferred Email [please add “CONTRACTOR EMAIL”] to your approved list of addresses to prevent it going to spam):      

3-5 Areas of Expertise*: (see attached list)      

Race/Ethnicity (voluntary; see below for more information): PLEASE RESPOND BELOW

Availability On All Review Dates: All days No, please explain:      

*Please also attach your latest resume or curricula vitae


VOLUNTARY QUESTIONS: Diversity of Membership of Peer Review Panels

The Administration for Children and Families, U. S. Department of Health and Human Services is committed to increasing the diversity of the non-Federal peer reviewers utilized in the competitive grants review process to the extent permitted by law.  You can help us achieve this goal by voluntarily indicating your race and/or ethnic heritage by checking the appropriate box for questions 1 thru 3. Please note that these questions utilize the standard Federal identification categories.  Your assistance is invaluable in enabling the agency to promote broad representation, especially for underserved and underrepresented groups and track our progress on this important goal. The information will not be used in the selection of grant reviewers for Office of Planning, Research and Evaluation discretionary grant programs. The information will be used solely to monitor the diversity of our grant reviewer pool.

  1. Voluntary - With which of the following racial classifications do you identify yourself? (Check all that apply)

__White

__Black or African American

__Asian

__Native Hawaiian or Pacific Islander

__American Indian or Alaskan Native

__Prefer not to answer



  1. Voluntary - With which of the following ethnic classifications do you identify yourself?

­­__Hispanic/Latino

__Not Hispanic/Latino

__Prefer not to answer

Expertise Sheet 1: Early Childhood

Please check all areas of expertise.


1. research methods


17. dual language learners/esl


33. cultural responsiveness


2. evaluation research/methods


18. special needs/developmental delays


34. other______________


3. implementation research


19. low income families


35. other______________


4. statistics/secondary analyses


20. American Indian/Alaskan native


36. other______________


5. assessment/measurement development


21. Migrants/Seasonal farmworker families


37. other______________


6. early education


22. parenting/parent-child interactions




7. child care


23.family engagement




8. child welfare


24. child behavior management




9. home visiting


25. social and emotional development/emotion regulation




10.Pre-k


26. school readiness




11. child care subsidies


27. health/nutrition/physical development




12. Head Start


28. language development




13. infants/toddler


29. literacy




14. preschool


30. math




15. homeless


31. program quality




16. foster care


32. professional development and training







Expertise Sheet 2: Welfare and Family Self-Sufficiency

Please check all areas of expertise.


1. research methods


15. two-generation programs


29. impacts of resource scarcity


2. evaluation research/methods


16. job search services


30. executive functioning


3. implementation research


17. employment and the labor market


31. goal-setting and self-regulation


4. statistics/secondary analyses


18. workforce development


32. coaching interventions


5. assessment/measurement development


19. subsidized and transitional employment


33. case management


6. low-income families and children


20. career pathways


34. program quality


7. homeless families and homelessness


32. WIOA coordination


35. disparities in human services


8. American Indian/Alaskan native populations


33. education and training


36. cultural responsiveness


9. Migrants/Seasonal farmworker families


23. financial literacy


37. other______________


10. poverty and income inequality


24. asset development


38. other______________


11. family self-sufficiency and stability


25. behavioral economics


39. other______________


12. social mobility


26. behavioral insights and applied behavioral sciences


40. other______________


13. Temporary Assistance for Needy Families


27. behavioral interventions




14. public assistance benefits and the safety net


28. psychology or neuroscience






Expertise Sheet 3: Family Strengthening

Please check all areas of expertise.


1. research methods






2. evaluation research/methods






3. implementation research






4. statistics/secondary analyses






5. assessment/measurement development






6. low-income families and children






7. marriage






8. marital conflict






9. relationship






10. other______________






11. other______________






12. other______________






13. other______________




















Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.



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AuthorPangburn, Renee
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File Created2021-01-14

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