Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Document Name	Status
Form 1 Child Welfare Program Improvement Plan Pilot Evaluation Form and Instruction	Unchanged
Form 1 2018 ANA Grantee Meeting Survey Form and Instruction	Unchanged
Form 1 Sexual Risk Avoidance (SRA) Social Media Marketing Campaign Form and Instruction	Unchanged
Form 1 Feedback on Strategies Related to Opioid Misuse Form and Instruction	Unchanged
Form 1 Adolescent Pregnancy Preventing Training & Technical Assistance Form and Instruction	Unchanged
Form 36 Course Participant Knowledge Gain Assessment and Instructior and Course Participant Experimental Feedback Form and Instruction	Unchanged
Form 1 Region XII MSHS T/TA Network Technical Assistance Services Delivery Feedback Form and Instruction	Unchanged
Form 1 Sexual Risk Avoidance (SRA) Social Media Marketing Campaign Form and Instruction	Unchanged
Form 1 Audience Research for Sexual Risk Avoidance (SRA) Social Media Marketing Campaign Form and Instruction	Unchanged
Form 1 State Capacity Building Center Tailored TA Feedback Collection for Impact Project Form and Instruction	Unchanged
Form 1 2019 Youth Summit Committe Planning Survey Form and Instruction	Unchanged
Form 1 2018 ANA Grantee Meeting Pre-Survey Form and Instruction	Unchanged
Form 1 HSICC Post Phone Call Survey Form and Instruction	Unchanged
Form 1 TA Assistance Feedback Collection for Webinars Form and Instruction	Unchanged
Form 1 Infant Toddler Specialist Network Training for Trainers (TFT) Form and Instruction	Unchanged
Form 1 Information Architecture Testing of the Early Childhood Learning and Knowledge Center Form and Instruction	Unchanged
Form 1 OFA TANF TA Convening Overall Evaluation Assessment Form and Instruction	Unchanged
Form 1 OFA TANF TA Convening Individual Session Assessment Form and Instruction	Unchanged
Form 1 ANA Youth Summit Survey Form and Instruction	Unchanged
Form 1 Region XII Migrant and Seasonal Head Start T/TA Service Deloivery Feedback Form and Instruction	Unchanged
Form 1 OHS TTA Network Training Feedback Form Form and Instruction	Unchanged
Form 1 Feedback Colection for Peer Leaning Form and Instruction	Unchanged
Form 1 Infant Toddler Specialist Presentation Form and Instruction	Unchanged
Form 1 Infant Toddler Spcialist Infividualized Technical Assistance Form and Instruction	Unchanged
Form 1 ECTTAS Coordination Survey Form and Instruction	Unchanged
Form 1 Communities of Practice Form and Instruction	Unchanged
Form 1 CCDF Administrator Feedback Collection Form and Instruction	Unchanged
Form 1 ACF Office of Regional Operations Curstomers Feedback for Learning Experiences Form and Instruction	Unchanged
Form 1 Regorous Evaluation Technical Assistance (RETA) Feedback Form Form and Instruction	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting (MEICHV) Continuous Quality Improvement Form and Instruction	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) TA Satisfaction Survey Form and Instruction	Unchanged
Form 1 Focus Group with Healthy Marriage and Relationship Education (HMRE) Form and Instruction	Unchanged
Form FRPN Feedback Inst Comment Form: Fatherhood Research and Practice Netrwork Learning Community Form and Instruction	Unchanged
Form 1 Child Welfare Information Gateway's Customer Satisfaction Assessment Form and Instruction	Unchanged
NonSub Change Request-PMFO Conference Feedback Form-7-17-20.docx Justification for No Material/Nonsubstantive Change	2020-07-17
Supporting Statement for Fast Track.docx Supporting Statement A	2018-02-20
Justification for Increase in Fast Track Burden Ceiling 5-17.docx Justification for No Material/Nonsubstantive Change	2017-05-31
ACF Nonmaterial Nonsubstantive Change Request.docx Justification for No Material/Nonsubstantive Change	2012-11-19

IC Document Collections

IC ID	Document Title	Status
244859	Tribal Home Visiting Evaluation Institute (TEI) Technical Assistance (TA) Satisfaction Survey Other-Evaluation Survey	New
244795	Feedback Related to PDG B-5 Technical Assistance Center Communities of Practice and Workgroups Other-Survey	New
244794	Feedback related to PDG B-5 Technical Assistance Center Tailored Technical Assistance Other-Survey	New
244793	Feedback Related to PDG B-5 Technical Assistance Center Webinars and Workshops Other-Survey	New
244792	Scale for Assessing the Attainment of Technical Assistance Outcomes Other-Survey	New
244768	Office of Refugee Resettlement Unaccompanied Alien Children (UAC) Path Pre Train-the-Trainer 2021 Survey Other-Survey	New
244574	Feedback related to PDG B-5 TA Center Annual All-Grantee Convening Other-Survey	New
244482	Feedback Survey for the NS2G Learning Community Calls Other-Feedback Survey	New
244481	Child Care Policy Research Partnership Community of Practice - Year 1 Customer Comments Other-Evaluation Form	New
244468	Runaway and Homeless Youth (RHY) Monitoring Site Visit 360 Feedback Forms Other-360 Feedback Form: Peer Monitor	New
244397	Native American Language Symposium Survey and Sessions Survey Other-Surveys	New
244393	Panelist and Chair post review surveys for the Family and Youth Services Bureau (FYSB) Discretionary Grant Programs Other-Survey	New
244378	Human-Centered Design (HCD) Primer Workshop Feedback Forms Other-Surveys	New
244377	Florida Prototype Project Pilot Feedback Other-Survey	New
244239	Center for States Internal Evaluation: Interviews with Jurisdictions Other-Interview Guide	New
244083	Evidence-Building Academy Daily Feedback Forms and Final Evaluation Form Other-Daily Feedback Form	New
243863	2020 OPRE Innovative Methods Meeting: Comment Form Other-Comment Form	New
243757	Administration for Native Americans (ANA) 2021 Grantee Meeting Logistics Survey Other-Pre-Meeting Survey	New
243722	Family and Youth Services Bureau (FYSB) Grantee COVID Survey Other-Survey	New
243543	CCDBG Implementation Research and Evaluation Grantee Community of Practice Meeting Evaluation Form Other-Evaluation Form	New
243212	Evidence-Building Academy Participant Project Update and Data Visualizations Other-Project Update Template	New
243197	Virtual meeting for soliciting feedback on recruitment and engagement strategies Other-Questions and Mode of Administration (Private Sector - Man	New
243078	Evidence Building Academy Midpoint Evaluation Form Other-Evaluation Form	New
242565	Office of Family Assistance PeerTA website Evaluation and Satisfaction Survey Other-Survey	Unchanged
242564	Peer-Based Technical Training and Technical Assistance Feedback Collection Activities Other-Survye	Unchanged
242468	Administration for Native Americans (ANA) 2020 Discretionary Application Process and Peer Panel Review Surveys Other-Survey	Unchanged
242408	Evidence-Building Academy Participant Project Introduction Other-Project Introduction	Unchanged
242233	Administration for Native Americans (ANA) 2020 Initiative for Leadership, Empowerment and Development (I-LEAD) Youth Webinar Series Surveys Other-Survey	Unchanged
241975	Runaway and Homeless Youth (RHY) Program Virtual Town Halls (Interactive Polling Questions) Other-Polling questions	Unchanged
241727	National Responsible Fatherhood Clearinghouse User Feedback and Content Other-null	Unchanged
241726	Poll questions for a National Runaway Safeline (NRS) webinar for grantees Other-polling questions	Unchanged
241608	Adolescent Pregnancy Prevention Training & Technical Assistance 2020 Conference Feedback Surveys Other-Survey	Unchanged
241330	Office of Refugee Resettlement (ORR) Refugee Programs Training and Technical Assistance Evaluation Other-Survey	Unchanged
240803	Sexual Risk Avoidance Education (SRAE) Grantee Needs Assessment Other-null	Unchanged
240765	Child Welfare Information Gateway Prevention Resource Guide Tip Sheet Feedback Form Other-Feedback Form	Unchanged
240738	Grantee Feedback for the FVPSA Formula Grantee Meeting Planning Other-Discussions	Unchanged
240445	In-Person Convening Child Care Policy Research Partnership – Participant Feedback Other-Survey	Unchanged
240340	Child Care and Development Block Grant (CCDBG) Implementation Research and Evaluation Grantees - Meeting Evaluation Form Other-Survey	Unchanged
240268	Program Management and Fiscal Operations (PMFO) Hurricane Response and Recovery (HRR) Feedback Survey. Other-Survey	Unchanged
240262	ACF State and County Human Services Commissioner Surveys Other-Survey	Unchanged
240138	Center for States 2020 Needs Assessment Survey Other-Survey	Unchanged
240136	Center for States Needs Assessment Focus Group Other-Focus Group Protocol	Unchanged
240130	Child Welfare Information Gateway Needs Assessment Focus Group Guide Other-Focus Group Guide	Unchanged
240123	Feedback on Child Care and Development Fund Plan for States/Territories for FFY 2019–2021 (ACF–118) Other-Focus Group Protocol	Unchanged
240100	2020 ACF Tribal Peer-to-Peer Grantee Meeting Survey Other-Survey	Unchanged
240054	Head Start Management Fellows (HSMF) Program Feedback Surveys Other-Survey	Unchanged
239998	Sexual Risk Avoidance Education (SRAE) Grantee Webinar Satisfaction Survey Other-Survey	Unchanged
239903	Grant Review Panel Chair Development Training Other-Feedback form	Unchanged
239893	Runaway and Homeless Youth (RHY) Regional Meeting Evaluation Other-Survey	Unchanged
239890	Public Assistance Reporting Information System (PARIS) Training Conference Post Event Survey Other-survey	Unchanged
239881	2020 ACF Native American Grantee Meeting Survey Other-Survey	Unchanged
239874	Feedback Survey for capacity building, grantee, training, online sessions hosted by the Family and Youth Services Bureau Other-Survey	Unchanged
239857	Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2020 Annual Meeting Other-Feedback Survey	Unchanged
239447	National Youth in Transition Database (NYTD) Technical Assistance Utilization and Needs Survey Other-Survey	Unchanged
239327	Child Care Development Block Grant (CCDBG) National Webinar Feedback Poll Other-Poll	Unchanged
239307	Grantee Exchange Platform Survey Other-Survey	Unchanged
239275	Feedback Survey for Human Trafficking webinars, online training, online sessions hosted by the Family and Youth Services Bureau Other-Survey	Unchanged
239218	Building Evidence Training (BET) Project Usability Testing Other-Attitude Scale	Unchanged
239176	New Director Mentor Program (NDMP) Feedback Surveys Other-Initial Survey	Unchanged
239130	Feedback on National Center on Parent, Family and Community Engagement (NCPFCE) Resources Other-Survey	Unchanged
239129	Leadership Initiative Feedback Surveys Other-Midpoint Survey	Unchanged
238866	Child Care and Development Fund (CCDF) Policies Database Pop-Up Survey of Website Users Other-survey	Unchanged
238687	In-Person Convening Child Care Policy Research Partnership - Participant Feedback Other-Survey	Unchanged
238492	Maternal, Infant, and Early Childhood Home Visiting All Grantee & Tribal Regional Meetings Feedback Tools Other-null	Unchanged
238491	Tribal Home Visiting Technical Assistance Evaluation Feedback and Immediate Feedback Forms Other-null	Unchanged
238489	Coaching Companion Questionnaire Other-Survey	Unchanged
238453	Family Violence Prevention and Services (FVPSA) 2020 Tribal Grantee Meeting Other-Questionnaires	Unchanged
238354	Program Management and Fiscal Operations (PMFO) Consulting Initiative (FCI) Feedback Surveys Other-Survey	Unchanged
238137	Program Management and Fiscal Operations (PMFO) Feedback Survey about the General Business Studies Certificate. Other-Survey	Unchanged
237946	Comment Form: 2019 OPRE Innovative Methods Meeting. Other-null	Unchanged
237891	Program Management and Fiscal Operations (PMFO) Feedback Surveys Other-survey	Modified
237884	Child Welfare Capacity Building Collaborative Customer Feedback for Webinars and Events Other-Questionnaire	Unchanged
237851	Child Care Development Block Grant (CCDBG) Implementation Research Webinar Feedback Poll Other-poll	Unchanged
237808	2019 National Runaway and Homeless Youth (RHY) Grantees Training Evaluations Other-Feedback Form	Unchanged
237594	Children's Bureau Grantee Connection Survey Other-survey	Unchanged
237590	Personal Responsibility Education Program (PREP) Grantee Training and Technical Assistance Satisfaction and Needs Assessment Other-survey	Unchanged
237543	Community Economic Development (CED) Grantee Training Needs Assessment Other-null	Unchanged
237542	Community Economic Development (CED) or Rural Community Development (RCD) Grantee Discussion Groups Other-Discussion Group	Unchanged
237266	Family Violence Prevention and Services (FVPSA) 2019 Tribal Grantee Meeting Other-null	Unchanged
237230	National Center on Early Childhood Health and Wellness (NCECHW) Infoline Feedback Form Other-null	Unchanged
237166	Children's Bureau Grantee Feedback Survey Other-null	Unchanged
237065	FY2019 New Capacity Building Center for States Community of Practice: County Administered State Support Interest Survey Other-Interest Survey	Unchanged
236885	2019 Reader Feedback: Brush Up on Oral Health Other-null	Unchanged
236033	Evaluation of Family Violence Prevention and Services Act (FVPSA) Regional Meeting Other-Survey	Unchanged
235817	2019 Low Income Home Energy Assistance Program (LIHEAP) Grantee Conference Feedback Other-null	Unchanged
235666	Administration for Native Americans (ANA) Application Submission Process Feedback Survey Other-survey	Unchanged
235646	Administration for Native Americans (ANA) Post Peer Panel Review Survey Other-null	Unchanged
235619	Runaway and Homeless Youth (RHY) Regional Meeting Evaluation Other-null	Unchanged
235540	Adolescent Pregnancy Prevention Training & Technical Assistance 2019 Conference Feedback Surveys Other-survey	Unchanged
235518	Feedback on Mixed-Delivery System and Service Coordination to Inform Appropriate, Tailored and Timely Technical Assistance Other-Survey	Unchanged
235432	Child Care Development Block Grant (CCDBG) Implementation Research and Evaluation Grantees - Meeting Evaluation Form Other-survey	Unchanged
235384	Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2019 Annual Meeting Other-Survey	Unchanged
235379	Sexual Risk Avoidance Education (SRAE) Grantee Training and Technical Assistance Satisfaction Survey Other-Survey	Unchanged
235370	Usability testing for the "Pathways to Work Evidence Clearinghouse" website Other-Protocol	Unchanged
235313	Child Welfare Information Gateway Subscription Form Other-subscription survey	Unchanged
234989	Feedback Survey for Technical and Training Assistance Activities for Family and Youth Services Bureau/ Runaway and Homeless Youth grantees Other-survey	Unchanged
234917	Listening Session Questions on OHS Training and Technical Assistance System Other-Survey	Unchanged
234737	Center for States Subscription Form Other-Subscription Form	Unchanged
234560	Child Welfare Program Improvement Plan Pilot Evaluation Form and Instruction	Unchanged
234505	Feedback on Webinars for Data Use and General Info for the National Survey of Early Care and Education (NSECE) Other-Registration Questions	Unchanged
234089	2018 ANA Grantee Meeting Survey Form and Instruction	Unchanged
234044	Sexual Risk Avoidance (SRA) Social Media Marketing Campaign Form and Instruction	Unchanged
233914	Feedback on Strategies Related to Opioid Misuse Form and Instruction	Unchanged
233701	Adolescent Pregnancy Preventing Training & Technical Assistance Form and Instruction	Unchanged
233652	Input on Key Functions of Early Care and Education Research Connections Website Other-Survey	Unchanged
233631	Maternal, Infant, and Early Childhood Home Visiting (MIECHV) AGM 2019 – Peer Sharing Feedback Survey Other-Feedback Form	Unchanged
233584	Course Participant Knowledge Gain Assessment and Instructior and Course Participant Experimental Feedback Form and Instruction	Unchanged
233090	Region XII MSHS T/TA Network Technical Assistance Services Delivery Feedback Form and Instruction	Unchanged
233069	Sexual Risk Avoidance (SRA) Social Media Marketing Campaign Form and Instruction	Unchanged
233068	Audience Research for Sexual Risk Avoidance (SRA) Social Media Marketing Campaign Form and Instruction	Unchanged
233066	State Capacity Building Center Tailored TA Feedback Collection for Impact Project Form and Instruction	Unchanged
233025	2019 Youth Summit Committe Planning Survey Form and Instruction	Unchanged
233024	Maternal, Infant, and Early Childhood Home Visiting (MIECHV) AGM 2019 – Peer Sharing Feedback Survey Other-Feedback Form	Unchanged
232814	2018 ANA Grantee Meeting Pre-Survey Form and Instruction	Unchanged
232746	HSICC Post Phone Call Survey Form and Instruction	Unchanged
232490	TA Assistance Feedback Collection for Webinars Form and Instruction	Unchanged
232488	Infant Toddler Specialist Network Training for Trainers (TFT) Form and Instruction	Unchanged
232184	Information Architecture Testing of the Early Childhood Learning and Knowledge Center Form and Instruction	Unchanged
232147	OFA TANF TA Convening Overall Evaluation Assessment Form and Instruction	Unchanged
232145	OFA TANF TA Convening Individual Session Assessment Form and Instruction	Unchanged
232142	ANA Youth Summit Survey Form and Instruction	Unchanged
232015	Comment Form: 2018 OPRE Innovative Methods Meeting. Other-Meeting Feedback Form	Unchanged
231867	Region XII Migrant and Seasonal Head Start T/TA Service Deloivery Feedback Form and Instruction	Unchanged
231683	OHS TTA Network Training Feedback Form Form and Instruction	Unchanged
231664	Feedback Colection for Peer Leaning Form and Instruction	Unchanged
231663	Infant Toddler Specialist Presentation Form and Instruction	Unchanged
231661	Infant Toddler Spcialist Infividualized Technical Assistance Form and Instruction	Unchanged
231659	ECTTAS Coordination Survey Form and Instruction	Unchanged
231658	Communities of Practice Form and Instruction	Unchanged
231657	CCDF Administrator Feedback Collection Form and Instruction	Unchanged
231551	nFORM Help Desk Customer Service Feedback Surveys Other-Survey	Unchanged
230092	ACF Office of Regional Operations Curstomers Feedback for Learning Experiences Form and Instruction	Unchanged
230091	Regorous Evaluation Technical Assistance (RETA) Feedback Form Form and Instruction	Unchanged
230090	Maternal, Infant, and Early Childhood Home Visiting (MEICHV) Continuous Quality Improvement Form and Instruction	Unchanged
230089	Maternal, Infant, and Early Childhood Home Visiting (MIECHV) TA Satisfaction Survey Form and Instruction	Unchanged
230088	Focus Group with Healthy Marriage and Relationship Education (HMRE) Form and Instruction	Unchanged
230087	Comment Form: Fatherhood Research and Practice Netrwork Learning Community Form and Instruction	Unchanged
230085	Child Welfare Information Gateway's Customer Satisfaction Assessment Form and Instruction	Unchanged

ICR Details

OMB Control No: 0970-0401	ICR Reference No: 202007-0970-006
Status: Active	Previous ICR Reference No: 201801-0970-013
Agency/Subagency: HHS/ACF	Agency Tracking No: OPRE
Title: Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/27/2020
	Date Received in OIRA: 07/20/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2021	05/31/2021	05/31/2021
Responses	44,124	0	44,124
Time Burden (Hours)	17,062	0	17,062
Cost Burden (Dollars)	0	0	0

---

Abstract: This is a generic request to seek feedback from the public on service delivery. This is in accordance with the Administrations's commitment to improving service delivery.

---

Authorizing Statute(s): PL: Pub.L. 110 - 134 125 Name of Law: Head Start Act of 2007
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 54345	11/17/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 6025	02/12/2018
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 138

IC Title	Form No.	Form Name
CCDBG Implementation Research and Evaluation Grantee Community of Practice Meeting Evaluation Form
Sexual Risk Avoidance (SRA) Social Media Marketing Campaign	1, 1, 1, 1, 1	Attachment 1 Discussion Prompts ,   CTK Parent Consent Form ,   CTK Youth Assent Form ,   Display ,   Youth Assent Form The Hive
Information Architecture Testing of the Early Childhood Learning and Knowledge Center	1	ECLKC-tree-jack survey instrument
2018 ANA Grantee Meeting Pre-Survey	1	Grantee Meeting Pre-Survey
Runaway and Homeless Youth (RHY) Regional Meeting Evaluation
Feedback Survey for Human Trafficking webinars, online training, online sessions hosted by the Family and Youth Services Bureau
National Center on Early Childhood Health and Wellness (NCECHW) Infoline Feedback Form
Program Management and Fiscal Operations (PMFO) Feedback Surveys
Coaching Companion Questionnaire
Child Care Development Block Grant (CCDBG) Implementation Research Webinar Feedback Poll
Program Management and Fiscal Operations (PMFO) Consulting Initiative (FCI) Feedback Surveys
Building Evidence Training (BET) Project Usability Testing
Adolescent Pregnancy Prevention Training & Technical Assistance 2020 Conference Feedback Surveys
Child Welfare Information Gateway Prevention Resource Guide Tip Sheet Feedback Form
Evidence-Building Academy Participant Project Introduction
Region XII MSHS T/TA Network Technical Assistance Services Delivery Feedback	1	Region-XII-TTA Feedback Form
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) AGM 2019 – Peer Sharing Feedback Survey
Child Welfare Information Gateway Subscription Form
Evaluation of Family Violence Prevention and Services Act (FVPSA) Regional Meeting
Sexual Risk Avoidance Education (SRAE) Grantee Training and Technical Assistance Satisfaction Survey
Feedback on Mixed-Delivery System and Service Coordination to Inform Appropriate, Tailored and Timely Technical Assistance
Feedback on Webinars for Data Use and General Info for the National Survey of Early Care and Education (NSECE)
Maternal, Infant, and Early Childhood Home Visiting All Grantee & Tribal Regional Meetings Feedback Tools
Child Welfare Capacity Building Collaborative Customer Feedback for Webinars and Events
FY2019 New Capacity Building Center for States Community of Practice: County Administered State Support Interest Survey
Center for States 2020 Needs Assessment Survey
Evidence-Building Academy Participant Project Update and Data Visualizations
Runaway and Homeless Youth (RHY) Regional Meeting Evaluation
Panelist and Chair post review surveys for the Family and Youth Services Bureau (FYSB) Discretionary Grant Programs
ACF Office of Regional Operations Curstomers Feedback for Learning Experiences	1	ORO Webinar or Meeting Feedback Survey
CCDF Administrator Feedback Collection	1	CCDF Administrators
Infant Toddler Spcialist Infividualized Technical Assistance	1	Infant Toddler Specialist Individualized Technical Assistance
OHS TTA Network Training Feedback Form	1	TTA Network Training Feedback
OFA TANF TA Convening Overall Evaluation Assessment	1	OFA Convening Overall Assessment
TA Assistance Feedback Collection for Webinars	1	Task 3 Webinars
2019 Youth Summit Committe Planning Survey	1	ILIAD 2019 Youth Summit Planning Committee Survey
Child Welfare Program Improvement Plan Pilot Evaluation	1, 1, 1, 1	PIPPilot ,   PIPPilot ,   PIPPilot Onsite Feedback Survey ,   PIPPilot PreonsiteFeedbackSurvey
Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2019 Annual Meeting
Sexual Risk Avoidance Education (SRAE) Grantee Webinar Satisfaction Survey
Center for States Subscription Form
Child Care and Development Fund (CCDF) Policies Database Pop-Up Survey of Website Users
Family Violence Prevention and Services (FVPSA) 2020 Tribal Grantee Meeting
Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2020 Annual Meeting
Evidence Building Academy Midpoint Evaluation Form
National Responsible Fatherhood Clearinghouse User Feedback and Content
Office of Refugee Resettlement (ORR) Refugee Programs Training and Technical Assistance Evaluation
Head Start Management Fellows (HSMF) Program Feedback Surveys
2020 ACF Tribal Peer-to-Peer Grantee Meeting Survey
Program Management and Fiscal Operations (PMFO) Hurricane Response and Recovery (HRR) Feedback Survey.
Feedback related to PDG B-5 Technical Assistance Center Tailored Technical Assistance
Grantee Feedback for the FVPSA Formula Grantee Meeting Planning
Administration for Native Americans (ANA) 2020 Discretionary Application Process and Peer Panel Review Surveys
Human-Centered Design (HCD) Primer Workshop Feedback Forms
Virtual meeting for soliciting feedback on recruitment and engagement strategies
2018 ANA Grantee Meeting Survey	1	ANA GM - Blank Survey Form
Child Welfare Information Gateway Needs Assessment Focus Group Guide
Poll questions for a National Runaway Safeline (NRS) webinar for grantees
Runaway and Homeless Youth (RHY) Program Virtual Town Halls (Interactive Polling Questions)
Child Care Development Block Grant (CCDBG) National Webinar Feedback Poll
Feedback Survey for the NS2G Learning Community Calls
Runaway and Homeless Youth (RHY) Monitoring Site Visit 360 Feedback Forms
Feedback related to PDG B-5 TA Center Annual All-Grantee Convening
Florida Prototype Project Pilot Feedback
Feedback Related to PDG B-5 Technical Assistance Center Webinars and Workshops
State Capacity Building Center Tailored TA Feedback Collection for Impact Project	1	OCC OMB SCBC Task 4 Impact Instrument
Region XII Migrant and Seasonal Head Start T/TA Service Deloivery Feedback	1	Service Delivery Feedback Form OHS Region 12
Infant Toddler Specialist Network Training for Trainers (TFT)	1	Traininging for Training
Feedback on Strategies Related to Opioid Misuse	1	Feedback Form on Strategies Related to Opioid Misuse
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) AGM 2019 – Peer Sharing Feedback Survey
Comment Form: 2019 OPRE Innovative Methods Meeting.
Child Care Development Block Grant (CCDBG) Implementation Research and Evaluation Grantees - Meeting Evaluation Form
Tribal Home Visiting Technical Assistance Evaluation Feedback and Immediate Feedback Forms
Administration for Native Americans (ANA) 2020 Initiative for Leadership, Empowerment and Development (I-LEAD) Youth Webinar Series Surveys
Center for States Needs Assessment Focus Group
ACF State and County Human Services Commissioner Surveys
2020 ACF Native American Grantee Meeting Survey
Administration for Native Americans (ANA) 2021 Grantee Meeting Logistics Survey
Office of Refugee Resettlement Unaccompanied Alien Children (UAC) Path Pre Train-the-Trainer 2021 Survey
Tribal Home Visiting Evaluation Institute (TEI) Technical Assistance (TA) Satisfaction Survey
Scale for Assessing the Attainment of Technical Assistance Outcomes
Feedback Related to PDG B-5 Technical Assistance Center Communities of Practice and Workgroups
2020 OPRE Innovative Methods Meeting: Comment Form
Center for States Internal Evaluation: Interviews with Jurisdictions
Regorous Evaluation Technical Assistance (RETA) Feedback Form	1	RETA-Feedback Form
Comment Form: Fatherhood Research and Practice Netrwork Learning Community	FRPN Feedback Instrument	FRPN Feedback Instrument
Maternal, Infant, and Early Childhood Home Visiting (MEICHV) Continuous Quality Improvement	1	MIECHV
OFA TANF TA Convening Individual Session Assessment	1	OFA Convening Individual Assessment
Audience Research for Sexual Risk Avoidance (SRA) Social Media Marketing Campaign	1, 1, 1	Attachment 1 ,   CTK Parent Consent Form ,   CTK Youth Assent Form
HSICC Post Phone Call Survey	1	Post Phone Calll Survey
Usability testing for the "Pathways to Work Evidence Clearinghouse" website
Sexual Risk Avoidance (SRA) Social Media Marketing Campaign	1	Social Norms Quiz
Children's Bureau Grantee Feedback Survey
Children's Bureau Grantee Connection Survey
Program Management and Fiscal Operations (PMFO) Feedback Survey about the General Business Studies Certificate.
2019 National Runaway and Homeless Youth (RHY) Grantees Training Evaluations
New Director Mentor Program (NDMP) Feedback Surveys
In-Person Convening Child Care Policy Research Partnership – Participant Feedback
Office of Family Assistance PeerTA website Evaluation and Satisfaction Survey
Public Assistance Reporting Information System (PARIS) Training Conference Post Event Survey
Child Care Policy Research Partnership Community of Practice - Year 1 Customer Comments
National Youth in Transition Database (NYTD) Technical Assistance Utilization and Needs Survey
Child Care and Development Block Grant (CCDBG) Implementation Research and Evaluation Grantees - Meeting Evaluation Form
Communities of Practice	1	Communities of Practice
Infant Toddler Specialist Presentation	1	Infant Toddler Specialist Presentations
Adolescent Pregnancy Preventing Training & Technical Assistance	1	Attachment 1-Survey
nFORM Help Desk Customer Service Feedback Surveys
Administration for Native Americans (ANA) Application Submission Process Feedback Survey
Input on Key Functions of Early Care and Education Research Connections Website
Adolescent Pregnancy Prevention Training & Technical Assistance 2019 Conference Feedback Surveys
2019 Low Income Home Energy Assistance Program (LIHEAP) Grantee Conference Feedback
Listening Session Questions on OHS Training and Technical Assistance System
Feedback Survey for Technical and Training Assistance Activities for Family and Youth Services Bureau/ Runaway and Homeless Youth grantees
Feedback on National Center on Parent, Family and Community Engagement (NCPFCE) Resources
Community Economic Development (CED) Grantee Training Needs Assessment
Community Economic Development (CED) or Rural Community Development (RCD) Grantee Discussion Groups
Personal Responsibility Education Program (PREP) Grantee Training and Technical Assistance Satisfaction and Needs Assessment
In-Person Convening Child Care Policy Research Partnership - Participant Feedback
Grantee Exchange Platform Survey
Leadership Initiative Feedback Surveys
Sexual Risk Avoidance Education (SRAE) Grantee Needs Assessment
Grant Review Panel Chair Development Training
Native American Language Symposium Survey and Sessions Survey
Family and Youth Services Bureau (FYSB) Grantee COVID Survey
Child Welfare Information Gateway's Customer Satisfaction Assessment	1	CWIG Customer Satisfaction Assessment Data Collection Instruments
Focus Group with Healthy Marriage and Relationship Education (HMRE)	1	SARHM generic OMB
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) TA Satisfaction Survey	1	DOHVE 2
ECTTAS Coordination Survey	1	ECTTAS Coordination Survey
Feedback Colection for Peer Leaning	1	Peer Learning
Course Participant Knowledge Gain Assessment and Instructior and Course Participant Experimental Feedback	36, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1	EBPAS-36 ,   Instructior Experience Survey Final ,   Instructor Unit Survey Final ,   Participant Experience Survey Final ,   Unit 1 Post Test Final ,   Unit 2 Post-Test Final ,   Unit 2 Pre-Test Final ,   Unit 3 Post-Test Final ,   Unit 3 Pre-Test Final ,   Unit 4 Post-Test Final ,   Unit 4 Pre--Test Final ,   Unit 5 Post-Test Final ,   Unit 5 Pre-Test Final ,   Unit 6 Post-Test Final ,   Unit 6 Pre-Test Final
Comment Form: 2018 OPRE Innovative Methods Meeting.
ANA Youth Summit Survey	1	2018 I-LEAD Youth Summiot Survey
Administration for Native Americans (ANA) Post Peer Panel Review Survey
Evidence-Building Academy Daily Feedback Forms and Final Evaluation Form
2019 Reader Feedback: Brush Up on Oral Health
Family Violence Prevention and Services (FVPSA) 2019 Tribal Grantee Meeting
Feedback on Child Care and Development Fund Plan for States/Territories for FFY 2019–2021 (ACF–118)
Feedback Survey for capacity building, grantee, training, online sessions hosted by the Family and Youth Services Bureau
Peer-Based Technical Training and Technical Assistance Feedback Collection Activities

---

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	44,124	44,124	0	0	0	0
Annual Time Burden (Hours)	17,062	17,062	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:

---

Annual Cost to Federal Government: $1,000

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.     No

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

---

Common Form ICR:  No

---

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: 07/20/2020

---