Certification of Maintenance of Effort

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0009 Supporting Statement for MOE-LTCO 1120.docx	Supporting Statement A	Uploaded 2020-11-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
10263	Certification of Maintenance of Effort	Instruction	Modified

ICR Details

OMB Control No: 0985-0009	ICR Reference No: 202010-0985-002
Status: Active	Previous ICR Reference No: 201710-0985-004
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: Certification of Maintenance of Effort
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/04/2021
	Date Received in OIRA: 11/30/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2024	36 Months From Approved	12/31/2020
Responses	112	0	56
Time Burden (Hours)	56	0	28
Cost Burden (Dollars)	0	0	0

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Abstract: The Administration for Community Living is requesting approval of the Certification of Maintenance of Effort for Title III and extension of, with minor revisions due to statutory language changes, to the Certification for Long-Term Care Ombudsman (LTCO) Program Expenditures, OMB number 0985-0009. Title III of the Older Americans Act, as amended, 42 USC 3029(c), requires that a State’s allotment for a given fiscal year be reduced by the percentage (if any) by which its expenditures from State sources are less than its average annual expenditures from such sources for the period of three consecutive fiscal years preceding such fiscal year. The information collected on the Federal Financial Report, SF 425, combines the funds from State and local sources, ACL is unable to identify expenditures solely from State sources without the requested financial data. Under Title III of the Older Americans Act, as amended, 42 USC 3027(a)(9), assurances are required from the State agency that they will carry out a State Long-Term Care Ombudsman Program and will expend for such purposes an amount that is not less than an amount expended by the State agency with funds received under Title III for fiscal year 2019. An additional assurance is established in Title VII of the Older Americans Act, as amended; 42 USC 3058d(a)(4) requires that the State will use funds made available in addition to, and will not supplant, any funds that are expended under Federal or State law. The LTCO data allows ACL to monitor compliance with these requirements.

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Authorizing Statute(s): PL: Pub.L. 45 - 49 1321 Name of Law: grantee cert of maintenance
   PL: Pub.L. 109 - 365 374 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:
	85 FR 51034	08/19/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 73274	11/17/2020
Did the Agency receive public comments on this ICR? No

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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
Certification of Maintenance of Effort	NA	ACL MOE

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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	112	56	0	0	56	0
Annual Time Burden (Hours)	56	28	0	0	28	0
Annual Cost Burden (Dollars)	0	0	0	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: There is an adjustment increase in the number of respondents. This is an extension without change to the currently approved ICR. There is an adjustment of 56 respondents from the previous collection year. All information collected on the current form was collected in the previous form.

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Annual Cost to Federal Government: $5,509

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

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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: 11/30/2020

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