OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Multi-Site Implementation Evaluation of Tribal Home Visiting

ICR 201912-0970-007 · OMB 0970-0521 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Supplemental Attachment to Non-Substantive Change Request 12.19.19.docx Justification for No Material/Nonsubstantive Change Uploaded 2019-12-31 Available
Supplemental Attachment for Non-Substantive 2 27 2019 CLEAN.docx Justification for No Material/Nonsubstantive Change Uploaded 2019-02-28 Available
ATTACHMENT L. Intro to MUSE Video Script FINAL_1.17.2019.pdf Supplementary Document Uploaded 2019-02-28 Repair queued
Attachment E - MIECHV Learning Agenda.docx Supplementary Document Uploaded 2018-12-21 Available
30 Day FRN_MUSE_8.10.18.pdf Supplementary Document Uploaded 2018-08-10 Repair queued
MUSE OMB Part B PASSBACK 1.17.19 FINAL CLEAN.pdf Supporting Statement B Uploaded 2019-02-28 Available
MUSE OMB Part A PASSBACK 1.17.19 FINAL CLEAN.pdf Supporting Statement A Uploaded 2019-02-28 Repair queued
ATTACHMENT J. Program Data Collection Reminders Emails 2.5.2019.pdf Supplementary Document Uploaded 2019-02-28 Repair queued
ATTACHMENT I. Caregiver Interview Invitation Phone Script FINAL.docx Supplementary Document Uploaded 2018-08-08 Repair queued
ATTACHMENT H. Staff Interview Invitation Email and Phone Script FINAL.docx Supplementary Document Uploaded 2018-08-08 Repair queued
ATTACHMENT G. Staff Survey Invitation Email 2.5.2019.pdf Supplementary Document Uploaded 2019-02-28 Repair queued
ATTACHMENT F. Caregiver Flyer 2.5.2019.pdf Supplementary Document Uploaded 2019-02-28 Repair queued
ATTACHMENT E. Caregiver Interviewee Selection Guide_12.19.2019_clean.docx Supplementary Document Uploaded 2019-12-31 Available
ATTACHMENT D. Documentation of Initial IRB Approval and Amendment Approval.pdf Supplementary Document Uploaded 2019-02-28 Available
ATTACHMENT C. Agreement to Keep Participant Data Private FINAL.doc Supplementary Document Uploaded 2018-08-08 Available
ATTACHMENT B. 60 Day Federal Register Notice.pdf Supplementary Document Uploaded 2018-07-27 Repair queued
ATTACHMENT A. Informed Consents 2.27.2019 CLEAN.pdf Supplementary Document Uploaded 2019-02-28 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
232432 16. MUSE Administrative Data Elements Other-Data Elements Modified
232431 15. MUSE Implementation Logs 7.9.18 CLEAN Other-Implementation Logs Unchanged
232430 14. MUSE Caregiver Interview Questions 7.9.18 CLEAN Other-Interview Questions Unchanged
232429 13. MUSE Local Evaluator Interview Questions 7.9.18 Other-Interview Questions Unchanged
232427 12. MUSE Program Coordinator-Manager and Program Director Interview Questions 7.9.18 Other-Interview Questions Unchanged
232426 11. MUSE Home Visitor Interview Questions 7.9.18 Other-Interview Questions Unchanged
232425 10. Program Implementation Survey 7.9.18 CLEAN Other-Survey Unchanged
232424 9. MUSE Local Program Evaluator Survey 7.9.18 CLEAN Other-Survey Unchanged
232423 8. MUSE Program Director Survey 7.25.18 CLEAN Other-Survey Unchanged
232422 7. MUSE Program Coordinator-Manager Survey 7.25.18 CLEAN Other-Survey Unchanged
232421 6. MUSE Home Visitor Survey 7.25.18 CLEAN Other-Survey Unchanged
232420 5. MUSE Rapid Reflect Home Visitor 7.25.18 CLEAN Other-Questionnaire Unchanged
232419 4. MUSE Rapid Reflect Caregiver 7.9.18 CLEAN Other-Questionnaire Unchanged
232418 3. MUSE Caregiver 6 12 Month Follow-Up Survey Other-Follow Up Survey Modified
232417 2. MUSE Caregiver Baseline Survey Other-Caregiver Baseline Survey Modified
232416 1. MUSE Caregiver Enrollment Form 7.9.18_CLEAN Other-Enrollment Form Unchanged
ICR Details
0970-0521 201912-0970-007
Historical Active 201902-0970-010
HHS/ACF OPRE
Multi-Site Implementation Evaluation of Tribal Home Visiting
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 01/08/2020
Retrieve Notice of Action (NOA) 01/02/2020
  Inventory as of this Action Requested Previously Approved
12/31/2021 12/31/2021 12/31/2021
7,752 0 7,752
2,240 0 2,240
0 0 0
This non-substantive change request includes updates to materials for the Multi-Site Implementation Evaluation of Tribal Home Visiting (MUSE) (OMB #0970-0521) to include 1) supplementary adapted versions of two instruments to be appropriate for telephone administration, 2) minor refinements to one study instrument, and 3) clarifications to the instructions related to caregiver interviews. The following revised materials are included with this submission: • Supplementary adapted Instruments 2 and 3 • Updated Instrument 16 • Updated Attachment E
US Code: 42 USC 711 Name of Law: Social Security Act Title V, Section 511 (42 USC section 711)
  
None
Not associated with rulemaking
  83 FR 8681 02/28/2018
83 FR 39759 08/10/2018
Yes
  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 7,752 7,752 0 0 0 0
Annual Time Burden (Hours) 2,240 2,240 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$654,783
Yes Part B of Supporting Statement
    Yes
    No
No
No
No
Uncollected
Molly Buck 202 205-4724 [email protected]
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
01/02/2020