Strategies To Respond to Intimate Violence Effectively (STRIVE)

Formative Data Collections for ACF Program Support

Documents and Forms

Document Name Document Type
Instrument 1. HMRE pre and post survey.docx Other-Survey
Instrument 2. RF pre and post survey.docx Other-Survey
Instrument 3. Contact information form.docx Other-Contact Info
Instrument 4. Implementation log.docx Other-Log
Instrument 5. Interview protocol for HMRF staff.docx Other-Interview protocol
STRIVE_Formative ACF Program Support_SSA_CLEAN.docx SSA Prog Support - STRIVE IC Document
STRIVE_Formative ACF Program Support_SSB_clean.docx SSB Prog Support - STRIVE IC Document
Attachment A. Study consent form for HMRF participants.docx Attachment A. Study consent form for HMRF participants IC Document
Attachment B. Study consent form for HMRF staff interviews.docx Attachment B. Study consent form for HMRF staff interviews IC Document
Attachment C. CUES safety card_HMRE programs.docx Attachment C. CUES safety card - HMRE programs IC Document
Attachment D. CUES safety card_RF programs.docx Attachment D. CUES safety card_RF programs IC Document
Attachment E. CUES safety card_AIAN participants CLEAN.docx Attachment E. CUES safety card_AIAN participants IC Document
Attachment F. Information and outreach scripts.docx Attachment F. Information and outreach scripts IC Document
NOA_OPRE STRIVE_Prog Supp GenIC_0970-0531_4.9.25.pdf NOA - STRIVE IC Document

Information Collection (IC) Details

IC Title:	Strategies To Respond to Intimate Violence Effectively (STRIVE)	Agency IC Tracking Number:	OPRE

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	Instrument 1. HMRE pre and post survey.docx	Yes	Yes	Fillable Fileable
Other-Survey	Instrument 2. RF pre and post survey.docx	Yes	Yes	Fillable Fileable
Other-Contact Info	Instrument 3. Contact information form.docx	Yes	Yes	Fillable Fileable
Other-Log	Instrument 4. Implementation log.docx	Yes	Yes	Fillable Fileable
Other-Interview protocol	Instrument 5. Interview protocol for HMRF staff.docx	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 356	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	392	392
Annual IC Time Burden (Hours)	175	175
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA Prog Support - STRIVE	STRIVE_Formative ACF Program Support_SSA_CLEAN.docx	08/25/2025
SSB Prog Support - STRIVE	STRIVE_Formative ACF Program Support_SSB_clean.docx	08/25/2025
Attachment A. Study consent form for HMRF participants	Attachment A. Study consent form for HMRF participants.docx	08/25/2025
Attachment B. Study consent form for HMRF staff interviews	Attachment B. Study consent form for HMRF staff interviews.docx	08/25/2025
Attachment C. CUES safety card - HMRE programs	Attachment C. CUES safety card_HMRE programs.docx	08/25/2025
Attachment D. CUES safety card_RF programs	Attachment D. CUES safety card_RF programs.docx	08/25/2025
Attachment E. CUES safety card_AIAN participants	Attachment E. CUES safety card_AIAN participants CLEAN.docx	08/25/2025
Attachment F. Information and outreach scripts	Attachment F. Information and outreach scripts.docx	08/25/2025
NOA - STRIVE	NOA_OPRE STRIVE_Prog Supp GenIC_0970-0531_4.9.25.pdf	08/25/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.