Maternal, Infant, and Early Childhood Home Visiting Program: Cost Reporting Tool for Pilot Test in Select Local Implementing Agencies

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Maternal, Infant and Early Childhood Home Visiting Program Home Visiting Budget Assistance Tool	Form and Instruction	New	Available
Form 1 HV-BAT	Form and Instruction	New	Repair queued
Form 1 HVBAT_FINAL_Revised 03.05.2020.xlsx	Form and Instruction	Removed	Available
Form 1 Home Visiting Budget Assistance Tool	Form and Instruction	Removed	Repair queued
HV-BAT_Supporting Statement A.docx	Supporting Statement A	Uploaded 2023-03-02	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
258858	HV-BAT	Form and Instruction	New	Maternal, Infant and Early Childhood Home Visiting Program Home Visiting Budget Assistance Tool
258858	HV-BAT	Form and Instruction	New
223574	Home Visiting Budget Assistance Tool	Form and Instruction	Removed	HVBAT_FINAL_Revised 03.05.2020.xlsx
223574	Home Visiting Budget Assistance Tool	Form and Instruction	Removed

ICR Details

OMB Control No: 0906-0025	ICR Reference No: 202303-0906-001
Status: Historical Active	Previous ICR Reference No: 202001-0906-001
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Maternal, Infant, and Early Childhood Home Visiting Program: Cost Reporting Tool for Pilot Test in Select Local Implementing Agencies
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: 06/12/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/02/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2026	36 Months From Approved	06/30/2023
Responses	247	0	247
Time Burden (Hours)	9,880	0	4,446
Cost Burden (Dollars)	0	0	0

---

Abstract: The Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) is authorized by the Social Security Act, Title V, § 511(c), as amended by Section 6101 of the Consolidated Appropriations Act, 2023 (P.L. 117-328). The MIECHV Program brings decades of research to fruition in supporting voluntary, evidence-based home visiting programs for expectant families and families with children up to kindergarten entry. States, certain non-profit organizations, and Tribal entities are eligible to receive funding from the MIECHV Program and have the flexibility to tailor the program to serve the specific needs of their communities. Awardees provide sub-awards to Local Implementing Agencies (LIAs) to provide evidence-based home visiting services to eligible families in at-risk communities. These programs are a critical component of a coordinated and cohesive system of support for families and young children. The MIECHV Program works to improve maternal and child health, prevent child abuse and neglect, encourage positive parenting, and promote child development and school readiness by implementing evidence-based home visiting models. Although there is strong evidence on the effectiveness of these models, limited consistent information about the costs to implement home visiting models and deliver services to families is available to guide policy decisions. The HV-BAT was developed to address this need by collecting standardized information about the real costs of delivering home visiting in a given reporting year.

---

Authorizing Statute(s): US Code: 42 USC 711(c), Section 511(c) of SSA Name of Law: Social Security Act Title V
   PL: Pub.L. 111 - 148 0 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 67481	11/08/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 12951	03/01/2023
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
HV-BAT	1	Maternal, Infant and Early Childhood Home Visiting Program Home Visiting Budget Assistance Tool
Home Visiting Budget Assistance Tool	1	HVBAT_FINAL_Revised 03.05.2020.xlsx

---

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	247	247	0	247	-247	0
Annual Time Burden (Hours)	9,880	4,446	0	9,880	-4,446	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: The request to increase the annual burden to 9,880 hours from the 4,446 hours currently approved is to be responsive to feedback received from the respondents and public comments, and not due to any changes to data collection tool.

---

Annual Cost to Federal Government: $166,351

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.     Yes

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? No

---

Common Form ICR:  No

---

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: 03/02/2023

---