Childhood & Family Experiences

Forms and Documents

Document Name	Status
Appendix K - Certificate of Confidentiality.pdf Supplementary Document	2018-07-19
Appendix J - Staff Outreach Script.docx Supplementary Document	2018-07-19
Appendix I - Adult Informed Consent Form.docx Supplementary Document	2018-07-19
Appendix H - Adolescent Informed Assent Participant Form.docx Supplementary Document	2018-07-19
Appendix G - Adolescent Informed Assent Interviewer Script.docx Supplementary Document	2018-07-19
Appendix F - Child Informed Assent Participant Form.docx Supplementary Document	2018-07-19
Appendix E - Child Informed Assent Interviewer Script.docx Supplementary Document	2018-07-19
C_FE Supporting Statement B - Final 2.21.19.docx Supporting Statement B	2019-02-22
C_FE Supporting Statement A - Final 2.21.19.docx Supporting Statement A	2019-02-22

IC Document Collections

IC ID	Document Title	Status
232316	Appendix D - Child Interview Guide (Ages 7-11) Other-Interview Guide	New
232315	Appendix C - Adolescent Interview Guide (Ages 12-17) Other-Interview Guide	New
232314	Appendix B - Adult Interview Guide Other-Interview Guide	New
232313	Appendix A - Phone Screener for Prospective Families Other-Screener	New

ICR Details

OMB Control No: 0970-0523	ICR Reference No: 201807-0970-016
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Childhood & Family Experiences
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: 02/25/2019
	Date Received in OIRA: 07/25/2018
Terms of Clearance: OMB is approving this information collection request for a period of one year during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2020	12 Months From Approved
Responses	215	0	0
Time Burden (Hours)	161	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services (HHS) seeks approval for data collection activities for a study that will examine the perspectives and lived experiences of children and families living in poverty. ACF seeks OMB approval for four data collection instruments that will be used as part of the site selection process and field interviews: - Phone Screener for Prospective Families (Appendix A) - Adult Interview Guide (Appendix B) - Adolescent Interview Guide (Ages 12-17) (Appendix C) - Child Interview Guide (Ages 7-11) (Appendix D) The proposed data collection activities will collect qualitative data about how children describe their lives materially; what children understand about their families’ economic circumstances; what children know about any public benefits that their families receive or do not receive; how children feel about any public benefits that their families receive or do not receive; how children interact with public assistance offices and workers; what the most salient aspects of families’ interactions with public assistance offices are; and how parents perceive their economic circumstances and/or benefit receipt as impacting their family and children. This justification provides supporting statements for each of the eighteen points outlined in Part A of the OMB guidelines.

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Authorizing Statute(s): PL: Pub.L. 115 - 31 413 Name of Law: Social Security Act, as amended by the FY 2017 Consolidated Appropriations Act, 2017
  

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:
	83 FR 2996	01/22/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 35275	07/25/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Appendix A - Phone Screener for Prospective Families
Appendix C - Adolescent Interview Guide (Ages 12-17)
Appendix B - Adult Interview Guide
Appendix D - Child Interview Guide (Ages 7-11)

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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	215	0	0	215	0	0
Annual Time Burden (Hours)	161	0	0	161	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.

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Annual Cost to Federal Government: $277,280

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 07/25/2018

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