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

Forms and Documents

Document Name	Status
Form 1 Early Head Start Conference Satisfaction Survey Form and Instruction	New
Form 1 OAS-TA State Systems Specialist Network Feedback Form and Instruction	New
Form 1 OAS-On-Site Meeting Facilitation State Feedback Collection Form and Instruction	New
Form 1 OAS-Administrator Feedback Collection Form and Instruction	New
Form 1 OAS-TA Feedback Collection for Infant Toddler Form and Instruction	New
Form 1 Follow-Up Needs Assessment Feedback Form Form and Instruction	New
Form 1 Institute Feedback Form Form and Instruction	New
Form 1 OAS-Specialized Resources TA Feedback Collection Form and Instruction	New
Form 1 Soliciatation of Opinions for 2017 ACF Native American Grantee Meeting Form and Instruction	New
Form 1 Human Trafficking Data Collection Pilot Form and Instruction	New
Form 1 ANA Sustainablility Servicers Survey Form and Instruction	New
Form 1 OCS-AFI Application Readiness Assessment Questions for Cohert Participants Form and Instruction	New
Form 1 HS-ECLKC Tree Testing Form and Instruction	New
Form 1 ANA Training and Technical Assistance Services Survey Form and Instruction	New
Form 1 ANA 2016 Communication Survey Form and Instruction	New
Form 1 PMFO New Director Mentor Iniative Form and Instruction	New
Form 1 AFI Capacity Building Toolkit Usability Test Form and Instruction	New
Form 1 AFI Grantee Workshop Evaluation Survey Form and Instruction	New
Form 1 PMFO Fiscal Consulting Inititative Feedback Survey Form and Instruction	New
Form 1 CWCB CapLEARN Form and Instruction	New
Form 1 Child Welfare Capacity Building Collaborative Focus Group Form and Instruction	New
Form 1 OHS-Fiscal Consulting Survey Form and Instruction	New
Form 1 OHS-Event Session Survey Form and Instruction	New
Form 1 OHS-Conference Feedback Survey Form and Instruction	New
Form 1 SOAR Human Trafficking Training End-of-Course Evaluation Form and Instruction	New
Form 1 Virtual Conference Session Evaluation Form and Instruction	New
Form 1 CWIG Virtual Conference Exit Survey Form and Instruction	New
Form 1 SOAR End of Course Evaluation Form and Instruction	New
Form 1 OTIP Form and Instruction	New
Form 1 National Foster Care and Adoption Directory Survey Form and Instruction	New
Form 1 Center for States - 2015 Form and Instruction	New
Form 1 Investigation and Analysis of AFI Form and Instruction	New
Form 1 Father Involvement Communication Checks Form and Instruction	New
Form 1 Child Welfare Information Gateways's Special Inititative Survey Form and Instruction	New
Form 1 BICS Vermont Grant Resolution Meeting Customer Satisfaction Form and Instruction	New
Form 1 Center for States Media Consumption Survey Form and Instruction	New
Form 1 Constituency Group Survey Form and Instruction	New
Form 1 OCS CED Focus Group Form and Instruction	New
Form 1 Special Initiative Survey Form and Instruction	New
Form 1 Capacity Building Collaborative Customer Feedback for Learning Experiences Form and Instruction	New
Form 1 AFI Outreach Survey Form and Instruction	New
Form 1 Collaborative Customer Feedback Form and Instruction	New
Form 1 Center for States Form and Instruction	New
Form 1 AFI Capacity Building Visit Form and Instruction	New
Form 1 Center for Urban Families (CFUF) Form and Instruction	New
Form 1 FEI Website Survey Form and Instruction	New
Form 1 FEI Focus Group Form and Instruction	New
Supporting Statement for Fast Track 1-15.docx Supporting Statement A	2015-02-04
ACF Nonmaterial Nonsubstantive Change Request.docx Justification for No Material/Nonsubstantive Change	2012-11-19

IC Document Collections

IC ID	Document Title	Status
227063	Early Head Start Conference Satisfaction Survey Form and Instruction	New
227009	MIECHV CQI Practicum, Mid-Practicum Feedback Questions Other-Survey	New
226904	OAS-TA State Systems Specialist Network Feedback Form and Instruction	New
226903	OAS-On-Site Meeting Facilitation State Feedback Collection Form and Instruction	New
226902	OAS-Administrator Feedback Collection Form and Instruction	New
226898	OAS-TA Feedback Collection for Infant Toddler Form and Instruction	New
226784	Follow-Up Needs Assessment Feedback Form Form and Instruction	New
226782	Institute Feedback Form Form and Instruction	New
226773	OAS-Specialized Resources TA Feedback Collection Form and Instruction	New
226527	Soliciatation of Opinions for 2017 ACF Native American Grantee Meeting Form and Instruction	New
226463	Human Trafficking Data Collection Pilot Form and Instruction	New
226361	ANA Sustainablility Servicers Survey Form and Instruction	New
225778	Participant Feedback Form for the CCDBG Implementation Research and Evaluation Planning Grantee Community of Practice Meeting Other-Feedback From	New
225714	Feedback on Mother and Infant Home Visiting Program Evaluation (MIHOPE) Long-term Follow-up study design options Other-Discussion Questions	New
225618	Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2017 Annual Meeting Other-Survey	New
225050	ACF Office of Regional Operations Customer Feedback for Learning Experiences Other-Survey	New
224993	OCS-AFI Application Readiness Assessment Questions for Cohert Participants Form and Instruction	New
224990	HS-ECLKC Tree Testing Form and Instruction	New
224679	ANA Training and Technical Assistance Services Survey Form and Instruction	New
224610	MIECHV Grantee Feedback on Data and Evaluation Technical Assistance Other-Small group discussion	New
224345	ANA 2016 Communication Survey Form and Instruction	New
223858	PMFO New Director Mentor Iniative Form and Instruction	New
223811	Input on Agenda for 2017 Annual Meeting of Child Care and Early Education Policy Research Consortium Other-Survey	New
223686	AFI Capacity Building Toolkit Usability Test Form and Instruction	New
223591	AFI Grantee Workshop Evaluation Survey Form and Instruction	New
223533	PMFO Fiscal Consulting Inititative Feedback Survey Form and Instruction	New
223306	CWCB CapLEARN Form and Instruction	New
223215	Child Welfare Capacity Building Collaborative Focus Group Form and Instruction	New
223172	OHS-Fiscal Consulting Survey Form and Instruction	New
223170	OHS-Event Session Survey Form and Instruction	New
223166	OHS-Conference Feedback Survey Form and Instruction	New
223017	SOAR Human Trafficking Training End-of-Course Evaluation Form and Instruction	New
222295	Virtual Conference Session Evaluation Form and Instruction	New
222294	CWIG Virtual Conference Exit Survey Form and Instruction	New
221800	SOAR End of Course Evaluation Form and Instruction	New
221738	OTIP Form and Instruction	New
221682	Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinars 3&4 Other-null	New
221461	National Foster Care and Adoption Directory Survey Form and Instruction	New
221111	Center for States - 2015 Form and Instruction	New
220980	Investigation and Analysis of AFI Form and Instruction	New
220065	Father Involvement Communication Checks Form and Instruction	New
220048	Child Welfare Information Gateways's Special Inititative Survey Form and Instruction	New
220018	BICS Vermont Grant Resolution Meeting Customer Satisfaction Form and Instruction	New
220013	Center for States Media Consumption Survey Form and Instruction	New
219984	Tribal MIECHV Data System Planning Other-Survey	New
219933	Constituency Group Survey Form and Instruction	New
219265	OCS CED Focus Group Form and Instruction	New
219240	Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinar Other-survey and polls	New
219077	Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting Other-Feedback form	New
218714	Special Initiative Survey Form and Instruction	New
218540	Capacity Building Collaborative Customer Feedback for Learning Experiences Form and Instruction	New
218317	AFI Outreach Survey Form and Instruction	New
218119	Collaborative Customer Feedback Form and Instruction	New
218106	Comment Form: 2015 OPRE Innovative Methods Meeting Other-Comment form	New
217606	Center for States Form and Instruction	New
217090	Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting Other-Survey	New
216671	AFI Capacity Building Visit Form and Instruction	New
216659	Center for Urban Families (CFUF) Form and Instruction	New
216644	FEI Website Survey Form and Instruction	New
216642	FEI Focus Group Form and Instruction	New

ICR Details

OMB Control No: 0970-0401	ICR Reference No: 201502-0970-004
Status: Historical Active	Previous ICR Reference No: 201211-0970-002
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/12/2015
	Date Received in OIRA: 02/24/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved	05/31/2015
Responses	14,124	0	32,090
Time Burden (Hours)	7,062	0	7,062
Cost Burden (Dollars)	0	0	0

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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.

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

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 69492	11/21/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 3606	01/23/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 60

IC Title	Form No.	Form Name
FEI Focus Group	1	Focus Group
Special Initiative Survey	1	Special Initiative Survey
OCS CED Focus Group	1	CED Grantee Needs Assessmenr
Child Welfare Information Gateways's Special Inititative Survey	1	CWIG Special Inititiative Survey for OMB 1-20-16
CWCB CapLEARN	1	CapLearn registration fields
AFI Capacity Building Toolkit Usability Test	1	Fast Track Toolkit Survey Instrument
ANA Sustainablility Servicers Survey	1	3 Year Posst Project Survey
FEI Website Survey	1	FEI Website Survey
Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinar
PMFO New Director Mentor Iniative	1	NDMI Live Learning Event Survey
ANA Training and Technical Assistance Services Survey	1	ANA TTA Survey Questions
Institute Feedback Form	1	Institute Feedback Form
OAS-TA State Systems Specialist Network Feedback	1	TA State Systems Network Feedback
MIECHV CQI Practicum, Mid-Practicum Feedback Questions
Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting
Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting
MIECHV Grantee Feedback on Data and Evaluation Technical Assistance
Human Trafficking Data Collection Pilot	1, 1	OTIP DCP Survey Questionnaire ,   DCP Stakeholder Interview Guide
AFI Outreach Survey	1	AFI Outreach Assessment
Collaborative Customer Feedback	1	Capacity Building Collaborative Customer Feedback Instrument
Capacity Building Collaborative Customer Feedback for Learning Experiences	1	Capacity Building Collaborative Customer Feedback Instrument
Father Involvement Communication Checks	1	Fatherhood Screener Comm Check
SOAR End of Course Evaluation	1	Justification
ACF Office of Regional Operations Customer Feedback for Learning Experiences
Soliciatation of Opinions for 2017 ACF Native American Grantee Meeting	1	IC for 2017 ACF Grantee Meeting
OAS-On-Site Meeting Facilitation State Feedback Collection	1	Meeting Facilitation
Follow-Up Needs Assessment Feedback Form	1	Follow-up Needsw Assessment Feedback Form
Center for Urban Families (CFUF)	1	National Responsible Fatherhood Clearinghouse (NRFC)
Center for States Media Consumption Survey	1	Media Consumption Survey Instrument
CWIG Virtual Conference Exit Survey	1	Exit Survey
PMFO Fiscal Consulting Inititative Feedback Survey	1	PMFO Fiscal Consulting Survey
AFI Grantee Workshop Evaluation Survey	1	Grantee Workshop Survey Instrument
Participant Feedback Form for the CCDBG Implementation Research and Evaluation Planning Grantee Community of Practice Meeting
AFI Capacity Building Visit	1	AFI Capacity Building Visit Feedback Form
Comment Form: 2015 OPRE Innovative Methods Meeting
National Foster Care and Adoption Directory Survey	1	NFCAD Survey
OHS-Conference Feedback Survey	1	PMFO Conference Survey
OHS-Event Session Survey	1	Event Session Survey
HS-ECLKC Tree Testing	1	ECLKC Tree Testing Script
OAS-TA Feedback Collection for Infant Toddler	1	SCBC Task 3
OAS-Specialized Resources TA Feedback Collection	1	SCBC Task 2
Center for States	1	Center for States Intensive Capacity Building Project
BICS Vermont Grant Resolution Meeting Customer Satisfaction	1	VT BICS Draft Questionaire 2-8-16
Tribal MIECHV Data System Planning
Constituency Group Survey	1	Fast Track Instrument
SOAR Human Trafficking Training End-of-Course Evaluation	1	SOAR End-of-Course Evaluation
Child Welfare Capacity Building Collaborative Focus Group	1	VirtualConference FocusGroupGuide
OHS-Fiscal Consulting Survey	1	Fiscal Consulting Survey
OCS-AFI Application Readiness Assessment Questions for Cohert Participants	1	AFI Instruction and Instruments.
Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2017 Annual Meeting
Early Head Start Conference Satisfaction Survey	1	Conference Satisfaction Survey
Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinars 3&4
Virtual Conference Session Evaluation	1	Generic Request
OTIP	1	OTIP Fast Track Request
Investigation and Analysis of AFI	1	AFI Outreach Instruments
Center for States - 2015	1	Center for States Needs Assessment Survey 2016
ANA 2016 Communication Survey	1	ANA Comms Survey Questions Survey Monkey
Input on Agenda for 2017 Annual Meeting of Child Care and Early Education Policy Research Consortium
Feedback on Mother and Infant Home Visiting Program Evaluation (MIHOPE) Long-term Follow-up study design options
OAS-Administrator Feedback Collection	1	Administrator Feedback Collection

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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	14,124	32,090	0	0	-17,966	0
Annual Time Burden (Hours)	7,062	7,062	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:

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Annual Cost to Federal Government: $1,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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? Uncollected

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Common Form ICR:  No

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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: 02/24/2015

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