Instructions for Annual Report on State Maintenance-of-Effort Programs: Form ACF-204

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form ACF-204 Annual Report on State MOE Programs	Form	Unchanged	Available
Form ACF-204 Annual Report on State MOE Programs	Form	Unchanged	Repair queued
Supporting Statement ACF-204 -final with 2022 updates_12.1.22.docx	Supporting Statement A	Uploaded 2022-12-06	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
10099	Annual Report on State MOE Programs	Form	Unchanged	Annual Report on State MOE Programs
10099	Annual Report on State MOE Programs	Form	Unchanged
10099	Annual Report on State MOE Programs	Instruction	Unchanged

ICR Details

OMB Control No: 0970-0248	ICR Reference No: 202212-0970-003
Status: Historical Active	Previous ICR Reference No: 201910-0970-009
Agency/Subagency: HHS/ACF	Agency Tracking No: OFA
Title: Instructions for Annual Report on State Maintenance-of-Effort Programs: Form ACF-204
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 without change	Conclusion Date: 03/15/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/07/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2026	36 Months From Approved
Responses	54	0	0
Time Burden (Hours)	6,372	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The report is used to collect descriptive program characteristics information on the programs operated by States and Territories in association with their Temporary Assistance for Needy Families (TANF) programs. All State and Territory expenditures claimed toward States and Territories Maintenance of Effort (MOE) requirements must be appropriate, i.e., meet all applicable MOE requirements. The Annual MOE Report provides the ability to learn about and to monitor the nature of State and Territory expenditures used to meet States and Territories MOE requirements, and it is an important source of information about the different ways that States and Territories are using their resources to help families attain and maintain self-sufficiency. In addition, the report is used to obtain State and Territory program characteristics for ACFs annual report to Congress, and the report serves as a useful resource to use in Congressional hearings about how TANF programs are evolving, in assessing State and Territory MOE expenditures, and in assessing the need for legislative changes.

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Authorizing Statute(s): US Code: 42 USC 611.f Name of Law: Social Security Act
  

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:
	87 FR 56055	09/13/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 75051	12/07/2022
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
Annual Report on State MOE Programs	ACF-204	Annual Report on State MOE Programs

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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	54	0	0	54	0	0
Annual Time Burden (Hours)	6,372	0	0	6,372	0	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: This request is for a reinstatement of the information collection under OMB #0970-0248. There are no program changes.

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Annual Cost to Federal Government: $19,591

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: 12/07/2022

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