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
Tribal MIECHV Supporting Statement to OMB_1.28.22.docx Supporting Statement A	2022-01-28

IC Document Collections

IC ID	Document Title	Status
221921	Tribal MIECHV Form 1: Demographic and Service Utilization Data and Service Form and Instruction	Modified

ICR Details

OMB Control No: 0970-0389	ICR Reference No: 202201-0970-011
Status: Received in OIRA	Previous ICR Reference No: 201905-0970-005
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	Date Submitted to OIRA: 02/02/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2022
Responses	23	25
Time Burden (Hours)	11,500	12,500
Cost Burden (Dollars)	0	0

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Abstract: Section 511 of the Social Security Act, created the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) and authorized the Secretary of the Department of Health and Human Services (HHS) (in Section 511(h)(2)(A)) to award grants to Indian tribes (or a consortium of Indian tribes), tribal organizations, or urban Indian organizations to conduct an early childhood home visiting program. The legislation set aside 3 percent of the total MIECHV program appropriation for grants to tribal entities. Tribal MIECHV grants, to the greatest extent practicable, are to be consistent with the requirements of the MIECHV grants to states and jurisdictions and include conducting a needs assessment and establishing quantifiable, measurable benchmarks. In Years 2-5 when Tribal MIECHV grantees are implementing home visiting services, they must submit to ACF Form 1: Demographic and Service Utilization Data to satisfy the legislative requirements of the program. Overall, this information collection provides valuable information to HHS that will guide understanding of Tribal MIECHV grantees and the provision of technical assistance (TA) needed to support the Tribal MIECHV Program. This request is for an extension with minor changes. Changes include adding a virtual home visit field and revising certain terms and definitions to make reporting on the areas more concise and easier for grantees to report.

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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:
	86 FR 66314	11/22/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 5823	02/02/2022
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
Tribal MIECHV Form 1: Demographic and Service Utilization Data and Service	1	Demographic and Service Utilization Data and Service

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ICR Summary of Burden

	Total Request	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	23	25	0	-2	0	0
Annual Time Burden (Hours)	11,500	12,500	0	-1,000	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Changes from the previous Form 1 are minor, including adding a virtual home visit field and revising certain terms and definitions to make reporting on the areas more concise and easier for grantees to report. There are no changes to the estimated response time, but the number of respondents has been reduced to reflect the current number of grantees.

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Annual Cost to Federal Government: $93,000

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? No

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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: 02/02/2022

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