Tribal Maternal, Infant, and Early Childhood Home Visiting Program Form 1: Demographic and Service Utilization Data

Forms and Documents

Document Name	Status
Form 1 Tribal MIECHV Form 1 Demographic and Service Utilization Data and Service Form and Instruction	Modified
Atttachment A 60 FRN Comments and Response.docx Supplementary Document	2019-05-15
THV Form 1 Supporting Statement 2019_final.doc Supporting Statement A	2019-05-15

IC Document Collections

IC ID	Document Title	Status
221921	Tribal MIECHV Form 1 Demographic and Service Utilization Data and Service Form and Instruction	Modified
221920	Tribal Maternal, Infant, and Early Childhood Home Visiting Implementation Plan Guidance Instruction	Removed

ICR Details

OMB Control No: 0970-0389	ICR Reference No: 201905-0970-005
Status: Active	Previous ICR Reference No: 201606-0970-002
Agency/Subagency: HHS/ACF	Agency Tracking No: OCC
Title: Tribal Maternal, Infant, and Early Childhood Home Visiting Program Form 1: Demographic and Service Utilization Data
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/17/2019
	Date Received in OIRA: 05/16/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2022	36 Months From Approved	08/31/2019
Responses	25	0	25
Time Burden (Hours)	12,500	0	16,666
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this information collection request is to renew and revise the existing approval under OMB No.: 0970-0389 (expires 8/31/19) to remove the Tribal Maternal, Infant, and Early Childhood Home Visiting Program Implementation Plan Guidance and only include Form 1: Demographic and Service Utilization Data. The Implementation Plan Guidance was specifically created to assist Tribal MIECHV Development and Implementation, and Implementation and Expansion grantees who originally received awards in FY2016 to develop their implementation plans (a requirement of their grant). These grantees successfully submitted their plans in 2018 and the guidance is no longer necessary. The Form 1 data are used to help ACF better understand the population receiving services from Tribal MIECHV grantees, the degree to which they are using services, as well as staffing data to better understand the Tribal MIECHV workforce. This includes data such as numbers of newly enrolled and continuing participants, educational level and poverty status of participants, gender and ethnicity of staff, and number of home visits. Overall, this information collection will provide valuable information to HHS that will guide understanding of Tribal MIECHV grantees and the provision of technical assistance needed to support the Tribal MIECHV Program. There are only minor changes proposed to the previously approved Form 1. Changes are meant to provide clearer guidance and refine some definitions. The data fields have not changed.

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Authorizing Statute(s): PL: Pub.L. 115 - 123 511(h)(2)(A) Name of Law: The Bipartisan Budget Act of 2018; Title V of SSA
  

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:
	84 FR 8528	03/08/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 22130	05/16/2019
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Tribal MIECHV Form 1 Demographic and Service Utilization Data and Service	1	Demographic and Service Utilization Data and Service
Tribal Maternal, Infant, and Early Childhood Home Visiting Implementation Plan Guidance

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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	25	25	0	0	0	0
Annual Time Burden (Hours)	12,500	16,666	0	-4,166	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The current collection includes guidance that was specifically created to assist Tribal MIECHV Development and Implementation and Implementation and Expansion grantees who originally received awards in FY2016 to develop their implementation plans (a requirement of their grant). These grantees successfully submitted their plans in 2018 and the guidance is no longer necessary. The program is therefore revising the collection to only include Tribal MIECHV Form 1, the form grantees use to submit their demographic and service utilization data. There are some changes proposed to the previously approved Form 1 to provide clearer guidance and refine some definitions. The data fields have not changed.

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Annual Cost to Federal Government: $86,200

Does this IC contain surveys, censuses, or employ statistical methods? No

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.     No

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: 05/16/2019

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