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OMB Control No: 0970-0454	ICR Reference No: 202201-0970-008
Status: Historical Active	Previous ICR Reference No: 201903-0970-001
Agency/Subagency: HHS/ACF	Agency Tracking No: OTIP
Title: Request for Certification of Adult Victims of Human Trafficking
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/21/2022
	Date Received in OIRA: 01/26/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2025	36 Months From Approved	04/30/2022
Responses	433	0	800
Time Burden (Hours)	433	0	400
Cost Burden (Dollars)	0	0	0

Abstract: The U.S. Department of Health and Human Services (HHS) provides letters of certification to foreign national victims of severe forms of trafficking in persons under the authority of the Trafficking Victims Protection Act of 2000 (TVPA), as amended 22 U.S.C. Section 7105(b)(1)(C) and (E). HHS delegated this authority to the Administration for Children and Families (ACF) Office of Trafficking in Persons (OTIP). Certification is required for foreign national adult victims of human trafficking in the United States to apply for federally funded benefits and services. OTIP developed a form for potential victims and their advocates, including case managers, attorneys, law enforcement officers, service providers, and other representatives to provide the required information for certification to HHS in accordance with the TVPA of 2000, as amended. The Request for Certification of Adult Victims of Human Trafficking (RFC) form (formerly titled Trafficking Victims Tracking System) was renamed in order to create consistency between the RFC and Request for Assistance for Child Victims of Human Trafficking (RFA) forms (OMB Control Number 0970-0362). Since the RFC form originally received clearance, OTIP modernized its request process and launched Shepherd, an online case management system, to process requests for certification and assistance on behalf of foreign national adult and minor victims of trafficking. The PDF version of the form should only be used in exceptional circumstances when the online case management system is inaccessible. If a requester encounters issues submitting a request through Shepherd, they may submit the RFC form to OTIP as a password protected PDF to Trafficking@acf.hhs.gov. The form asks the requester for their identifying information, identifying information for the foreign national adult in the event the form is submitted by a case manager, and information describing the victim’s case management service needs. The minor revisions made to this form enable OTIP to better fulfill its mandate in accordance with the TVPA of 2000, as amended. These revisions also enable OTIP to be more responsive to congressional inquiries, federal reporting requirements, and the needs of victims, as the information provided will be factored into policy and program development efforts.

Authorizing Statute(s): US Code: 22 USC 7105 Name of Law: Trafficking Victims Protection Act of 2000, as amended

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 61276	11/05/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 4033	01/26/2022
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
Request for Certification of Foreign National Adult Victims of Human Trafficking	1

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	433	800	-367
Annual Time Burden (Hours)	433	400	33
Annual Cost Burden (Dollars)	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: No

Burden Reduction Due to:

Short Statement: The Request for Certification of Adult Victims of Human Trafficking (RFC) form (formerly titled Trafficking Victims Tracking System) was renamed in order to create consistency between the RFC and Request for Assistance for Child Victims of Human Trafficking (RFA) forms (OMB Control Number 0970-0362). Since the RFC form originally received clearance, OTIP modernized its request process. Now, users can submit both the RFC for foreign national adults and the RFA for foreign national minors through OTIP’s online Shepherd case management system as webforms. The PDF version of the form should only be used in exceptional circumstances when the online case management system is inaccessible. Instructions for submitting the request through the Shepherd case management system are provided in Attachment B: Shepherd RFC Webform Instructions. The other minor updates made to the RFC described below enable OTIP to better fulfill its mandate in accordance with the TVPA of 2000, as amended, and to be more responsive to congressional inquiries, federal reporting requirements, and the needs of victims, as the information provided will be factored into policy and program development efforts. Specific updates are detailed in A15 of Supporting Statement A.

Annual Cost to Federal Government: $45,370

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. 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? No

Agency Contact: Molly Buck 202 205-4724 mary.buck@acf.hhs.gov

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