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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0970-0521
ICR Reference No:
201912-0970-007
Status:
Historical Active
Previous ICR Reference No:
201902-0970-010
Agency/Subagency:
HHS/ACF
Agency Tracking No:
OPRE
Title:
Multi-Site Implementation Evaluation of Tribal Home Visiting
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
01/08/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
01/02/2020
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2021
12/31/2021
12/31/2021
Responses
7,752
0
7,752
Time Burden (Hours)
2,240
0
2,240
Cost Burden (Dollars)
0
0
0
Abstract:
This non-substantive change request includes updates to materials for the Multi-Site Implementation Evaluation of Tribal Home Visiting (MUSE) (OMB #0970-0521) to include 1) supplementary adapted versions of two instruments to be appropriate for telephone administration, 2) minor refinements to one study instrument, and 3) clarifications to the instructions related to caregiver interviews. The following revised materials are included with this submission: • Supplementary adapted Instruments 2 and 3 • Updated Instrument 16 • Updated Attachment E
Authorizing Statute(s):
US Code:
42 USC 711
Name of Law: Social Security Act Title V, Section 511 (42 USC section 711)
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:
83 FR 8681
02/28/2018
30-day Notice:
Federal Register Citation:
Citation Date:
83 FR 39759
08/10/2018
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
16
IC Title
Form No.
Form Name
1. MUSE Caregiver Enrollment Form 7.9.18_CLEAN
10. Program Implementation Survey 7.9.18 CLEAN
11. MUSE Home Visitor Interview Questions 7.9.18
12. MUSE Program Coordinator-Manager and Program Director Interview Questions 7.9.18
13. MUSE Local Evaluator Interview Questions 7.9.18
14. MUSE Caregiver Interview Questions 7.9.18 CLEAN
15. MUSE Implementation Logs 7.9.18 CLEAN
16. MUSE Administrative Data Elements
2. MUSE Caregiver Baseline Survey
3. MUSE Caregiver 6 12 Month Follow-Up Survey
4. MUSE Rapid Reflect Caregiver 7.9.18 CLEAN
5. MUSE Rapid Reflect Home Visitor 7.25.18 CLEAN
6. MUSE Home Visitor Survey 7.25.18 CLEAN
7. MUSE Program Coordinator-Manager Survey 7.25.18 CLEAN
8. MUSE Program Director Survey 7.25.18 CLEAN
9. MUSE Local Program Evaluator Survey 7.9.18 CLEAN
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
7,752
7,752
0
0
0
0
Annual Time Burden (Hours)
2,240
2,240
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:
$654,783
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
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.
Yes
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
Agency Contact:
Molly Buck 202 205-4724 mary.buck@acf.hhs.gov
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:
01/02/2020
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