Social Innovation Fund Pay for Success Process Evaluation

Forms and Documents

Document Name	Status
Form 1 Social Innovation Fund Pay for Success Process Evaluation Survey Form and Instruction	New
SIF PFS OMB Part B_02_05_16.docx Supporting Statement B	2016-03-11
SIF PFS OMB Part A_02.05.16.docx Supporting Statement A	2016-03-11

IC Document Collections

IC ID	Document Title	Status
220595	Social Innovation Fund Pay for Success Process Evaluation Survey Form and Instruction	New

ICR Details

OMB Control No: 3045-0177	ICR Reference No: 201603-3045-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: CNCS	Agency Tracking No:
Title: Social Innovation Fund Pay for Success Process Evaluation
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 without change	Conclusion Date: 05/13/2016
	Date Received in OIRA: 03/11/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2019	36 Months From Approved
Responses	260	0	0
Time Burden (Hours)	87	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CNCS has contracted with Abt Associates to support CNCS’s Office of Research and Evaluation to implement a process evaluation of the Social Innovation Fund (SIF) Pay for Success (PFS) Program. The major data collection activities to be undertaken subject to this notice will include two surveys: (1) Grantee Survey, and (2) Subrecipient/Service Recipient Survey. Survey information will be collected from current and future SIF PFS grantees and their subrecipients/service recipients through an online survey program. The purpose of the Grantee Survey is to better understand grantees’ program structure, practices in providing technical assistance and deal structuring activities.

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Authorizing Statute(s): US Code: 42 USC 12501 et seq Name of Law: National Community Service Act of 1990, as amended
  

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:
	80 FR 76848	12/11/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 12880	03/11/2016
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Social Innovation Fund Pay for Success Process Evaluation Survey	1	SIF Pay for Success Process Evaluation Survey Instruments

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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	260	0	0	260	0	0
Annual Time Burden (Hours)	87	0	0	87	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: The net burden has increased because this is a new information collection.

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Annual Cost to Federal Government: $0

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: 03/11/2016

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