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
NonSub Change Request Tribal MIECHV Form1 4-29-22.docx Justification for No Material/Nonsubstantive Change	2022-04-29
NonSub Change Request Tribal MIECHV Form1.docx Justification for No Material/Nonsubstantive Change	2022-04-05
30 FRN Comments and Response - Tribal MIECHV Form 1_0970-0389.docx Supplementary Document	2022-03-31
Final Tribal MIECHV Supporting Statement to OMB 3.31.22.docx Supporting Statement A	2022-03-31

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: 202204-0970-021
Status: Received in OIRA	Previous ICR Reference No: 202204-0970-002
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: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/02/2022

	Requested	Previously Approved
Expiration Date	04/30/2025	04/30/2025
Responses	23	23
Time Burden (Hours)	11,500	11,500
Cost Burden (Dollars)	0	0

---

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. The Tribal Maternal, Infant, and Early Childhood Home Visiting Program Form 1: Demographic and Service Utilization Data (OMB #0970-0389) was renewed on April 1, 2022. The categories of staff listed under the recently approved Instructions and Definitions of Key Terms include 4 categories: Home Visitors, Project Directors/Managers/Coordinators, Data/Evaluation Staff and Project Support Staff. After submitting a nonsubstantive change request, category fields were added to the actual form to match the approved Instructions and Definitions of Key Terms. Further analysis of costs associated with modifying and adding the Data/Evaluation Staff and Project Support Staff fields in the Tribal Home Visiting Reporting System (THVRS) to match the Form 1 nonsubstantive change is not the best value to the Government at this time. The data has been determined not to be necessary for the overall purpose/use of the data collection. The change request is to eliminate rows in Form 1 that cover the 2 staff categories (Data/Evaluation Staff and Project Support Staff) that are included in the approved Instructions and Definitions of Key Terms portion of the information collection under Section B Program Staff Characteristics. The change request is minor and ensures accurate reporting. A sentence has been added in the Instructions and Definitions of Key Terms appendix to assist grantees when reporting in the system under Section B Program Staff Characteristics.

---

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

---

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:
	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

---

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

---

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	23	0	0	0	0
Annual Time Burden (Hours)	11,500	11,500	0	0	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: No

Burden Reduction Due to:

Short Statement:

---

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

---

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: 05/02/2022

---