Maternal, Infant and Early Childhood Home Visiting Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
194248	Statewide and At Risk Community Needs Assessment		New

ICR Details

OMB Control No: 0915-0333	ICR Reference No: 201008-0915-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Maternal, Infant and Early Childhood Home Visiting Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 08/14/2010
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/18/2010
	Date Received in OIRA: 08/13/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2011	6 Months From Approved
Responses	56	0	0
Time Burden (Hours)	1,344	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The statewide and at risk community needs assessment portion of the Maternal, Infant and Early Childhood Home Visiting Program is required as a condition for receiving FY 2011 Title V Block Grant allotments. Section 2951 authorizes the creation of the Home Visiting Program, which is designed: (1) to strengthen and improve the programs and activities carried out under Title V; (2) to improve coordination of services for at risk communities; and (3) to identify and provide comprehensive services to improve outcomes for families who reside in at risk communities.

Emergency Justfication: This is a critical emergency request. The OMB desk officer has directed the agency to submit an ICR immediately due to the urgency of the required information collection from entities funded under Section 2951 of the Patient Protection and Affordable Care Act.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 2951 Name of Law: Maternal, Infant and Early Childhood Home Visiting Programs
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 2951 Name of Law: Maternal, Infant and Early Childhood Home Visiting Programs

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking
	Other Documents for OIRA Review

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Statewide and At Risk Community Needs Assessment	SEC 2591 ATT A

---

ICR Summary of Burden

table that charts list 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	56	0	56	0	0	0
Annual Time Burden (Hours)	1,344	0	1,344	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: This is a program change of a total estimated 1,344 hours for grantees to provide a statewide and at risk community needs assessment required as a condition of receiving payment of FY2011 Title V Block Grant funds.

---

Annual Cost to Federal Government: $3,561

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

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: 08/13/2010

---