The Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report	Form and Instruction	Modified	Available
Attachment B - 60-day FRN MIECHV Quarterly Data Collection 0906-0016.pdf	Supplementary Document	Uploaded 2018-12-19	Available
Supporting Statement A 0906-0016 Revise and Extend.docx	Supporting Statement A	Uploaded 2018-12-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218304	Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report	Form and Instruction	Modified

ICR Details

OMB Control No: 0906-0016	ICR Reference No: 201812-0906-002
Status: Active	Previous ICR Reference No: 201509-0906-002
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: The Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/14/2019
	Date Received in OIRA: 12/21/2018
Terms of Clearance: Approved consistent with the understanding that there will be a transition period to the new 30-day reporting period, which may include deadline extensions that could result in a 45 day submission window

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2022	36 Months From Approved	03/31/2019
Responses	264	0	536
Time Burden (Hours)	13,376	0	13,440
Cost Burden (Dollars)	0	0	0

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Abstract: HRSA is seeking to revise and extend collection of select service utilization and performance benchmark information on a quarterly basis in order to continuously monitor and provide oversight and quality improvement guidance and technical assistance to MIECHV awardees. The respondents will be state and territorial governments.

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Authorizing Statute(s): US Code: 42 USC 701 Name of Law: Patient Protection Affordable Care Act 2010
  

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:
	83 FR 7481	02/21/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 64847	12/18/2018
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

IC Title	Form No.	Form Name
Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report	1	Attachment A - Form 4 - MIECHV Quarterly Performance Report.pdf

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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	264	536	0	-272	0	0
Annual Time Burden (Hours)	13,376	13,440	0	-64	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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: In general, revisions being requested to this form are for the purposes of streamlining reporting requirements and reducing administrative burden related to data collection and reporting. These revisions will better align the intended and actual uses of these data for program monitoring and oversight purposes.

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Annual Cost to Federal Government: $278,301

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]? Yes

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: 12/21/2018

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