Request for Assistance for Child Victims of Human Trafficking

Forms and Documents

Document Name	Status
Form 1 Request for Assistance for Child Victims of Human Trafficking Form and Instruction	Modified
Supporting Statement 041614.doc Supporting Statement A	2014-11-13
Attachment A_TVPA U.S. Code cite authorizing collection of information.doc Supplementary Document	2009-04-10
ATIP Social Services Migrant Poster.pdf Supplementary Document	2009-04-10
ATIP Sex Trafficking Poster.pdf Supplementary Document	2009-04-10

IC Document Collections

IC ID	Document Title	Status
188787	Request for Assistance for Child Victims of Human Trafficking Form and Instruction	Modified

ICR Details

OMB Control No: 0970-0362	ICR Reference No: 201411-0970-003
Status: Historical Active	Previous ICR Reference No: 201108-0970-008
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Request for Assistance for Child Victims of Human Trafficking
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/03/2015
	Date Received in OIRA: 11/18/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2018	36 Months From Approved	02/28/2015
Responses	40	0	200
Time Burden (Hours)	40	0	200
Cost Burden (Dollars)	0	0	0

---

Abstract: The TVPRA 2008 directs HHS upon receipt of credible information that a non-U.S. citizen, non-lawful permanent resident (alien) child may have been subjected to a severe form of trafficking in persons and is seeking Federal assistance available to victims of trafficking, to promptly determine if the child is eligble for interim assistance. The law further directs HSS to determine if the child is eligble for assistance as a victim of a severe form of trafficking in persons after consultation with the Attorney General, the Secretary of Homeland Security, and nongovernmental organizations with expertise on victims of severe form of trafficking. In developing procedures for collecting the neccessary informaiton from potential child victims of trafficking, their case managers, attorneys, or other representatives to allow HHS to grant interim eligbility, HHS devised a form. HHS has determined that the use of a standard form to collect iformation is the best way to ensure requestors are notified of their option to request assistance for child victims of trafficking and to make prompt and consistent determinations about the child's eligbility for interim assistance. Specifcially, the form asks the requestor for his/her identifying information, for information on the child, information describing the type of trafficking and circumstances surrounding the situation, and the strengths and needs of the child. The form also asks the requestor to verify the information contained in the form becuase the information could be the basis for a determination of an alien child's eligibiltiy for federally funded benefits. Finally, the form takes into consideration the need to compile information regarding a child's circumstances and experiences in a non-directive, child-friendly way, and assists the potential requestor in assessing whether the child may have been subjected to trafficking in persons.

---

Authorizing Statute(s): PL: Pub.L. 110 - 457 212 Name of Law: TVPRA
  

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:
	79 FR 10528	02/25/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 67167	11/11/2014
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
Request for Assistance for Child Victims of Human Trafficking	1	Request for Assistance Form

---

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	40	200	0	0	-160	0
Annual Time Burden (Hours)	40	200	0	0	-160	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: Several small technical changes in addition to the reduction in the number of respondents.

---

Annual Cost to Federal Government: $11,200

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

---

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: 11/18/2014

---