Compassion Capital Fund Evaluation -- Intermediary Survey

Forms and Documents

Document Name	Status
A-10 Revised 2-15-07.doc Supplementary Document	2007-02-15
OMB Justification-Supporting Statement Int Survey 10-30-06.doc Supporting Statement B	2006-11-27
OMB Justification-Supporting Statement Int Survey 10-30-06.doc Supporting Statement A	2006-11-27

IC Document Collections

IC ID	Document Title	Status
46369	Survey Other-Other	New

ICR Details

OMB Control No: 0970-0316	ICR Reference No: 200612-0970-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Compassion Capital Fund Evaluation -- Intermediary Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/16/2007
	Date Received in OIRA: 12/07/2006
Terms of Clearance: This ICR is approved consistent with changes made to the supporting statement and survey instrument, as reflected in the February 13 version of the instrument and the February 15 revision to the supporting statement. This ICR is also approved on the understanding that ACF will take a cautious approach in interpreting these results: ACF will consider factors such as possible non-response bias and bias resulting from respondents being in different stages of their grant cycle when analyzing and reporting results. Because ACF does not have the statutory authority to provide assurances of confidentiality for this ICR, ACF will not use the term "confidential" in its correspondence with respondents and will use other appropriate language as necessary.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2010	36 Months From Approved
Responses	54	0	0
Time Burden (Hours)	27	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This is a survey of CCF intermediary grantees who provide the services to faith-based and community organizations (fbcos) being evaluated through the CCF evaluation. The survey seeks systematic information about the organizations and their approach to provision of services. The information gathered will be used in interpreting the responses from fbcos in the outcome and impact components of the CCF evaluation.

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 46260	08/11/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 63325	10/30/2006
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Survey

---

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	54	0	0	54	0	0
Annual Time Burden (Hours)	27	0	0	27	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection for a component of an ongoing evaluation.

---

Annual Cost to Federal Government: $60

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(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: 11/28/2006

---