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OMB Control No: 0970-0389	ICR Reference No: 202204-0970-002
Status: Historical Active	Previous ICR Reference No: 202201-0970-011
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
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/15/2022
	Date Received in OIRA: 04/05/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2025	04/30/2025	04/30/2025
Responses	23	0	23
Time Burden (Hours)	11,500	0	11,500
Cost Burden (Dollars)	0	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. This request is for nonsubstantive changes to the recently approved form. 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. In the approved Form 1, rows for the following categories were inadvertently not included: Data/Evaluation Staff and Project Support Staff. These categories need to be added to the actual form to match the approved Instructions and Definitions of Key Terms.

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

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	23	23
Annual Time Burden (Hours)	11,500	11,500
Annual Cost Burden (Dollars)	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

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

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