NOA - Tribal MIECHV Quarterly Performance Reporting Form 4

NOTICE OF OFFICE OF MANAGEMENT AND BUDGET ACTION
Date

12/08/2021

Department of Health and Human Services
Administration for Children and Families
FOR CERTIFYING OFFICIAL:

Janet Vogel

FOR CLEARANCE OFFICER:

Terry Clark

In accordance with the Paperwork Reduction Act, OMB has taken action on your request received
11/16/2021
ACTION REQUESTED: Generic IC
Tribal Maternal, Infant, and Early Childhood Home Visiting Program Form 4: Quarterly Performance
IC TITLE:
Reporting Form
ICR REFERENCE NUMBER:
202110-0970-013
AGENCY ICR TRACKING NUMBER:
TITLE:

OPRE

Generic Performance Progress Report

LIST OF INFORMATION COLLECTIONS: See next page
OMB ACTION: Approved without change
OMB CONTROL NUMBER:

0970-0490

The agency is required to display the OMB Control Number and inform respondents of its legal significance in
accordance with 5 CFR 1320.5(b).
EXPIRATION DATE: 01/31/2023

BURDEN:

DISCONTINUE DATE:

RESPONSES

HOURS

COSTS

Previous

1,739

6,789

0

New

1,739

6,789

0

Change due to New Statute

0

0

0

Change due to Agency Discretion

0

0

0

Change due to Agency Adjustment

0

0

0

Change due to PRA Violation

0

0

0

Difference

TERMS OF CLEARANCE:

Terms of the Generic ICR remain in effect.

OMB Authorizing Official:

Dominic J. Mancini
Deputy Administrator,
Office Of Information And Regulatory Affairs

IC Title
ORR Refugee Family
Child Care
Microenterprise
Program Performance
Data
Survivors of Torture
Program Data Points
Preferred Communities
Program Data Points
Refugee Individual
Development Accounts
(IDA) Program
Indicators
Refugee Health
Promotion Data
Indicators
Refugee Resettlement
Refugee Career
Pathways Program
Performance Data
Head Start
Collaboration Office
Annual Report
Refugee Agricultural
Partnership Program
(RAPP)
Preschool Development
Grant Birth through Five
(PDG B-5) Renewal
Grant Performance
Progress Report
Community
Collaborations to
Strengthen and
Preserve Families
Semiannual ACF
Performance Progress
Report; Appendix B Program Indicators
Ethnic Community SelfHelp (ECSH) Program
Data Indicators
Microenterprise
Development Program
Indicators
Wilson-Fish Alternative
Program Fiscal Year
Recipient Report
ORR Department of
Unaccompanied
Children Operations
(DUCO); Home Study
(HS) and Post Release
(PRS) Grantee Data
Collection
Human Trafficking
Youth Prevention
Education (HTYPE)
Demonstration Grant
Program Performance
Indicators

Form No.

List of ICs
Form Name

CFR Citation

Hrs/$/Resp

1

RFCCMED Performance
Data

48 / 0 / 24

1

SOT Program Data Points

210 / 0 / 35

1

Preferred Communities
Program Data Points
Refugee IDA Program
Indicators

135 / 0 / 27

1

RHP Program Data
Indicators Form

123 / 0 / 41

1

RCP Performance Data

170 / 0 / 34

1

HSCO Annual Report

162 / 0 / 54

1

Refugee Agricultural
Partnership Program
(RAPP) Indicators
PDG B-5 Renewal Grant
Performance Progress
Report

66 / 0 / 30

1

Community Collaborations
to Strengthen and
Preserve Families
Semiannual ACF
Performance Progress
Report; Appendix B Program Indicators

208 / 0 / 26

1

ECSH Program Data
Indicators

80 / 0 / 40

1

MED Semi-Annual Report
Submission Form

84 / 0 / 42

1

Wilson-Fish Alternative
Program Fiscal Year
Recipient Report
ORR DUCO HS PRS
Grantee Data Collection

52 / 0 / 26

1

1

1

160 / 0 / 80

141 / 0 / 47

440 / 0 / 44

48 / 0 / 8

IC Title
Wilson-Fish TANF
Coordination Project
Performance Report
Part A and B

Form No.
Part B, Part A

List of ICs
Form Name
Wilson Fish TANF
Coordination Project
Performance Report Part
B, Wilson Fish TANF
Coordination Project
Performance Report Part
A
ARP EL Post Project
Report, ARP EL Progress
Report

CFR Citation

Administration for
2, 1
Native Americans
(ANA) American
Rescue Plan
Emergency Language
(ARP EL) Progress
Report and Post Project
Report.
Tribal Maternal, Infant, 4
Tribal MIECHV Quarterly
and Early Childhood
Performance Reporting
Home Visiting Program
Form
Form 4: Quarterly
Performance Reporting
Form
Total Hours Actually Used for Information Collections Under Currently Approved ICR:

Hrs/$/Resp
252 / 0 / 42

317 / 0 / 422

276 / 0 / 92

2,972