Tribal Maternal, Infant, and
Early Childhood Home Visiting Program Form 1: Demographic and
Service Utilization Data
No
material or nonsubstantive change to a currently approved
collection
No
Regular
05/02/2022
Requested
Previously Approved
04/30/2025
04/30/2025
23
23
11,500
11,500
0
0
Section 511 of the Social Security
Act, created the Maternal, Infant, and Early Childhood Home
Visiting Program (MIECHV) and authorized the Secretary of the
Department of Health and Human Services (HHS) (in Section
511(h)(2)(A)) to award grants to Indian tribes (or a consortium of
Indian tribes), tribal organizations, or urban Indian organizations
to conduct an early childhood home visiting program. The
legislation set aside 3 percent of the total MIECHV program
appropriation for grants to tribal entities. Tribal MIECHV grants,
to the greatest extent practicable, are to be consistent with the
requirements of the MIECHV grants to states and jurisdictions and
include conducting a needs assessment and establishing
quantifiable, measurable benchmarks. In Years 2-5 when Tribal
MIECHV grantees are implementing home visiting services, they must
submit to ACF Form 1: Demographic and Service Utilization Data to
satisfy the legislative requirements of the program. Overall, this
information collection provides valuable information to HHS that
will guide understanding of Tribal MIECHV grantees and the
provision of technical assistance (TA) needed to support the Tribal
MIECHV Program. The Tribal Maternal, Infant, and Early Childhood
Home Visiting Program Form 1: Demographic and Service Utilization
Data (OMB #0970-0389) was renewed on April 1, 2022. The categories
of staff listed under the recently approved Instructions and
Definitions of Key Terms include 4 categories: Home Visitors,
Project Directors/Managers/Coordinators, Data/Evaluation Staff and
Project Support Staff. After submitting a nonsubstantive change
request, category fields were added to the actual form to match the
approved Instructions and Definitions of Key Terms. Further
analysis of costs associated with modifying and adding the
Data/Evaluation Staff and Project Support Staff fields in the
Tribal Home Visiting Reporting System (THVRS) to match the Form 1
nonsubstantive change is not the best value to the Government at
this time. The data has been determined not to be necessary for the
overall purpose/use of the data collection. The change request is
to eliminate rows in Form 1 that cover the 2 staff categories
(Data/Evaluation Staff and Project Support Staff) that are included
in the approved Instructions and Definitions of Key Terms portion
of the information collection under Section B Program Staff
Characteristics. The change request is minor and ensures accurate
reporting. A sentence has been added in the Instructions and
Definitions of Key Terms appendix to assist grantees when reporting
in the system under Section B Program Staff
Characteristics.
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:
(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;
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.
Form 1 Tribal MIECHV Form 1: Demographic and Service Utilization Data and Service
NonSub Change Request Tribal MIECHV Form1 4-29-22.docx
Tribal MIECHV Form 1: Demographic and Service Utilization Data and Service