View Information Collection Request (ICR) Package

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: 0906-0017	ICR Reference No: 202603-0906-002
Status: Active	Previous ICR Reference No: 202503-0906-001
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Maternal, Infant, and Early Childhood Home Visiting Program Performance Measurement Information System
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: 05/01/2026
	Date Received in OIRA: 03/13/2026
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2029	36 Months From Approved	09/30/2027
Responses	280	0	56
Time Burden (Hours)	73,416	0	43,736
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	280	56	224
Annual Time Burden (Hours)	73,416	43,736	29,680
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: Changes have been made to MIECHV Forms 1, 2 and 4. Forms 1 and 2 are included in the currently approved package for OMB No. 0906-0017). Form 4 was approved through a separate ICR: OMB No. 0906-0016. HRSA is seeking to combine all information collection forms through a single ICR in this revision package. However, rather than reflecting a true increase in burden, the updated burden estimate reflects actual burden data more accurately for each form. As stated above in Section 12A, HRSA conducted a survey under OMB No. 0906-0094 in summer 2024 where awardees reported approximate actual burden hours to complete information collection. We are not adjusting the number of the forms to avoid confusion from respondents.

Annual Cost to Federal Government: $882,628

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: Laura Cooper 301 443-2126 lcooper@hrsa.gov

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