The Head Start Program Performance Standards (HSPPS) regulations on eligibility in 45 CFR 1302.12 is published under the authority granted to the Secretary of Health and Human Services under the Head Start Act, as amended, (42 USC 9801 et seq) at sections 644(c), 645(a)(1)(A), and 645A(c).
There is no standardized document for grantees to use for any of the eligibility determination requirements in 45 CFR 1302.12. Still, OHS developed this sample form to assist grantees in collecting information to meet record keeping requirements for eligibility determination records. The sample form facilitates an efficient and accurate determination and documentation of eligibility for Head Start. However, Head Start programs are not required to use this specific form. Grantees may adapt this sample form or design a form that is relevant to their program in order to meet the requirements.
Programs must store eligibility determination records as long as the child is enrolled and for one year after they have either stopped receiving services or are no longer enrolled. They can be maintained electronically or in hard copy. This form can be part of that eligibility determination record alongside other documentation required as part the record.
The Office of Head Start is requesting an extension, with changes, of the Head Start Eligibility Verification. Changes are minor and provide some additional clarification to the form.
The overall burden has been greatly reduced due to the revised HSPPS. The previously approved information collection under this OMB # had a calculated burden of 124,520 hours. This covered the burden to complete the full eligibility determination record, which included filling out the form itself among other record keeping requirements from the prior HSPPS. These record keeping requirements and the burden associated were addressed and accounted for during the rule-making process of the new HSPPS (see Federal Register Notice 81 FR 61293 and OMB #0970-0148 for burden approved under the new HSPPS). The only burden associated with this revised information collection request is now the standalone estimated burden in filling out the form which is estimated to take 1.5 minutes per response.
There is a slight decrease to the annual number of respondents.
The annualized cost in section A12 was updated per new OMB guidance.
$0
No
Yes
No
No
No
No
Uncollected
Molly Buck 202 205-4724 mary.buck@acf.hhs.gov
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.
Form 1 Eligibility Verification Form
0970-0374-Eligibility Verification-Supporting Statement-2019_April 2019.doc
1305.4(l) Other Record Keeping