| Note: Staff using this form will be trained on it prior to use. Instructions will also be added to this document after it has been tailored to meet each grantee's needs. |
| Note: The Paperwork Reduction Act Statement: The associated collections of information is voluntary and will be used to gather preliminary information about the fatherhood field and explore with fatherhood programs the research questions that are of interest and the design options that are feasible. 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. Public reporting burden for this collection of information is estimated to average five minutes. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Dina Israel; Dina.Israel@mdrc.org; and Michelle Manno; michelle.manno@mdrc.org, Attn: OMB-PRA (xxxxxxxx; Expiration xxxxxx). |
| PRIVACY STATEMENT: This Table is covered by the Privacy Act. This means that your participation is voluntary, so you can decline to participate. The purpose of this study is to find out which parts of fatherhood programs are the most effective at improving the lives of participating fathers and their children and co-parents. The information you provide may be shared with state and federal agencies and researchers involved in similar work. The legal authority for this project is [insert funding stream for the project]. If you would like more information about this project, please see Systems of Records Notice (SORN) 09-80-0361, OPRE Research and Evaluation Project Records. |
| Fatherhood TIES: TIES Table | Summary of Planned Program Activities | ||||||||||
| Participant Information | Planned/Scheduled Implementation | |||||||||
| nFORM ID | Group (BAU=Business as Usual / TIES) | Location | Participant Status | Date Activity to Occur | Activity Info 1 (tailored to grantee; e.g. type or location of activity) |
Activity Info 2 (tailored to grantee) |
Activity Info 3 (tailored to grantee) |
Result 1 (tailored to grantee; e.g. did participant attend) |
Result 2 (tailored to grantee) |
Result 3 (tailored to grantee) |
| Fatherhood TIES: TIES Table | Details about Activity Implementation | |||||||
| nFORM ID | Research Group |
Date of Activity |
Activity Facilitator (tailored to grantee) |
Topic(s) Discussed (tailored to grantee) |
Activity Attendees (tailored to grantee) |
Intervention-Specific Info (tailored to grantee) |
Study-specific Incentives (tailored to grantee) |
| File Type | application/zip |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |