Appendix A_SIMR OMB_Evaluation Plan Template_12-14-20_clean

APPENDIX A
Evaluation Plan Template for
Healthy Marriage and Relationship Education Grantees

Appendix B. Evaluation Plan Template for Healthy Marriage and Relationship Education Grantees

[Feel free to add graphic or logo]

Evaluation of [Intervention Name] in [Geographic Area]
Evaluation Plan for
[Grantee Organization]

[Date]

Prepared by

[Evaluation authors with each author’s affiliation]

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this collection is 0970-0356; this number is valid through 06/30/2021. Public reporting burden for this collection of information is estimated to average 8 hours, including the time for reviewing instructions, gathering and maintaining the data needed, reviewing the collection of information, and revising it. This collection of information is voluntary for individuals, but the information is required from Grantees. It will be used to gather information about the healthy marriage and relationship education grantees with proposed local evaluations. Send comments regarding burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Robert Wood; rwood@mathematica-mpr.com

Evaluation of [Intervention Name] In [Geographic Area]

I. Research Question(s)

A. Background

[Start writing here.]

B. Research question(s)

[Start writing here.]

C. Relation to program logic model

[Start writing here.]

D. Hypotheses

[Start writing here.]

II. Research Design and Staff

A. Research design

[Start writing here.]

B. Methods to develop study groups

[Start writing here.]

C. Sample

[Start writing here.]

D. Lead staff

[Start writing here.]

E. Ongoing coordination between grantee and local evaluator

[Start writing here.]

III. Data Collection

A. Data collection

[Start writing here.]

IV. Data Analysis

A. Data analysis

[Start writing here.]

V. Privacy and Data Security

A. Privacy

[Start writing here.]

B. IRB/protection of human subjects

[Start writing here.]

C. Data

[Start writing here.]

D. Data archiving and transfer

[Start writing here.]

VI. Dissemination

A. Dissemination

[Start writing here.]

VII. References

[Start writing here.]

VIII. Appendices

A. Logic model (or theory of change) for the program

B. Curriculum vitae

C. Federal-Wide Assurance