Annual Statistical Report on Children in Foster Homes and in Families Receiving Payments in Excess of the Poverty Income Level from a State Program

Forms and Documents

Document Name	Status
Form ACF 4125 Annual Statistical Report on Children in Foster Homes and in Families Receiving Payments in Excess of the Poverty Income Level from a State Program Form	Modified
SupportStatment-c 0970-0004.doc Supporting Statement A	2017-12-14
ACF 4125 Report PI.pdf Supplementary Document	2011-11-08

IC Document Collections

IC ID	Document Title	Status
9787	Annual Statistical Report on Children in Foster Homes and in Families Receiving Payments in Excess of the Poverty Income Level from a State Program Form	Modified

ICR Details

OMB Control No: 0970-0004	ICR Reference No: 201712-0970-003
Status: Active	Previous ICR Reference No: 201409-0970-003
Agency/Subagency: HHS/ACF	Agency Tracking No: OFA
Title: Annual Statistical Report on Children in Foster Homes and in Families Receiving Payments in Excess of the Poverty Income Level from a State Program
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/28/2018
	Date Received in OIRA: 12/14/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2021	36 Months From Approved
Responses	52	0	0
Time Burden (Hours)	13,746	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: DHHS is required to collect these data under section 1124 of Title I of the Elementary and Secondary Education Act, as amended by PL 103-382. The data are used by the U.S. Department of Education for allocation of funds for programs to aid disadvantaged elementary and secondary students. Respondents include various components of State Human Service agencies.

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Authorizing Statute(s): US Code: 1 USC 1124 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 45028	09/27/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 57758	12/07/2017
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Annual Statistical Report on Children in Foster Homes and in Families Receiving Payments in Excess of the Poverty Income Level from a State Program	ACF 4125	Annual Statistical Report on Children in Foster Homes and in Families Receiving Payments in Excess of the Poverty Income Level from a State Program

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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	52	0	0	0	0	52
Annual Time Burden (Hours)	13,746	0	0	0	0	13,746
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:

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Annual Cost to Federal Government: $8,400

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? Uncollected

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Common Form ICR:  No

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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: 12/14/2017

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