[NCIPC] Reporting of the Essentials for Childhood (EfC): Preventing Adverse Childhood Experiences through Data to Action Program

ICR 202507-0920-007

OMB: 0920-1425

Federal Form Document

Forms and Documents

Document Name	Status
Form 0920 Instrument and Protocol Implementation Capacity Assessment (ICA) Form and Instruction	Unchanged
Form 0920 Essentials Instrument and Protocol Evaluation and Surveillance Survey Form and Instruction	Modified
Form 0920 Instrument and Protocol Surveillance Capacity Assessment (SCA) Form and Instruction	Unchanged
Form 0920 Instrument and Protocol Key Informant Interview - Principal Investigators/Implementer Form and Instruction	Unchanged
Form 0920 Instrument and Protocol Key Informant Interview - Principal Investigators Form and Instruction	Unchanged
Form 0920- Annual Performance Report (APR) Tool Form and Instruction	Modified
Change Request Memo - EO14168 Updates Essentials for Childhood.docx Justification for No Material/Nonsubstantive Change	2025-07-10
SSB_EfC_Program_9_14_23.docx Supporting Statement B	2023-10-25
SSA_EfC Program_050125 EO clean.docx Supporting Statement A	2025-07-10
Att. 8 Research Determination.pdf Supplementary Document	2023-10-12
Att. 7 EfC-ICR-PII-Privacy Act-Determination.pdf Supplementary Document	2023-10-12
Att. 1_PHSA_301a_USC_241a and Section 393USC 280b-1a.pdf Supplementary Document	2023-10-12

IC Document Collections

IC ID	Document Title	Status
262779	Instrument and Protocol Implementation Capacity Assessment (ICA) Form and Instruction	Unchanged
262777	Essentials Instrument and Protocol Evaluation and Surveillance Survey Form and Instruction	Modified
262776	Instrument and Protocol Surveillance Capacity Assessment (SCA) Form and Instruction	Unchanged
262775	Instrument and Protocol Key Informant Interview - Principal Investigators/Implementer Form and Instruction	Unchanged
262773	Instrument and Protocol Key Informant Interview - Principal Investigators Form and Instruction	Unchanged
262771	Annual Performance Report (APR) Tool Form and Instruction	Modified