Tribal Maternal, Infant, and Early Childhood Home Visiting Program Data Reports: Demographic and Service Utilization, Grantee Performance Measures and Quarterly Performance Reports

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form QPR Tribal MIECHV Quarterly Performance Report	Form and Instruction	New	Available
Form QPR Tribal MIECHV Quarterly Performance Report	Form and Instruction	New	Repair queued
Form PMR Tribal MIECHV Performance Measures Report	Form and Instruction	New	Available
Form PMR Tribal MIECHV Performance Measures Report	Form and Instruction	New	Repair queued
Form DSUR Tribal MIECHV Demographic & Service Utilization Data Report	Form and Instruction	New	Available
Form DSUR Tribal MIECHV Demographic & Service Utilization Data Report (Families)	Form and Instruction	New	Repair queued
Form DSUR Tribal MIECHV Demographic & Service Utilization Data Report	Form and Instruction	New	Available
Form DSUR Tribal MIECHV Demographic & Service Utilization Data Report (Grantees)	Form and Instruction	New	Repair queued
THV Reporting Guidance Supporting Statement 6.14.23.docx	Supporting Statement A	Uploaded 2023-06-14	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
260666	Tribal MIECHV Quarterly Performance Report	Form and Instruction	New	Tribal MIECHV Quarterly Performance Report
260666	Tribal MIECHV Quarterly Performance Report	Form and Instruction	New
260665	Tribal MIECHV Performance Measures Report	Form and Instruction	New	Tribal MIECHV Performance Measures Report
260665	Tribal MIECHV Performance Measures Report	Form and Instruction	New
260664	Tribal MIECHV Demographic & Service Utilization Data Report (Families)	Form and Instruction	New	Tribal MIECHV Demographic & Service Utilization Data Report
260664	Tribal MIECHV Demographic & Service Utilization Data Report (Families)	Form and Instruction	New
260663	Tribal MIECHV Demographic & Service Utilization Data Report (Grantees)	Form and Instruction	New	Tribal MIECHV Demographic & Service Utilization Data Report
260663	Tribal MIECHV Demographic & Service Utilization Data Report (Grantees)	Form and Instruction	New

ICR Details

OMB Control No: 0970-0614	ICR Reference No: 202306-0970-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Tribal Maternal, Infant, and Early Childhood Home Visiting Program Data Reports: Demographic and Service Utilization, Grantee Performance Measures and Quarterly Performance Reports
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/11/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/20/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2026	36 Months From Approved
Responses	2,018	0	0
Time Burden (Hours)	34,214	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 511 Title V of the Social Security Act created the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program and authorized the Secretary of the Department of Health and Human Services (HHS) to award grants to Indian tribes (or a consortium of Indian tribes), tribal organizations, or urban Indian organizations. The most recent reauthorization of the MIECHV program set aside 6 percent of the total MIECHV program appropriation for grants to tribal entities and indicates that the Tribal MIECHV grants, to the greatest extent practicable, be consistent with the requirements of the MIECHV grants to states and territories and include conducting a needs assessment and establishing benchmarks. The goals of the Tribal MIECHV home visiting program are to support healthy, happy, successful American Indian and Alaska Native (AIAN) children and families through a coordinated, high-quality, evidence-based home visiting strategy, and to continue to build the evidence base for home visiting in tribal communities. The Administration for Children and Families (ACF) and the Health Resources and Services Administration (HRSA), the agencies collaborating to implement the MIECHV program within HHS, also intend for the program to result in a coordinated system of early childhood home visiting in tribal communities that has the capacity to provide infrastructure and supports to assure high-quality, evidence-based practice. The Tribal MIECHV discretionary grants support cooperative agreements to conduct community needs assessments; plan for and implement high-quality, culturally relevant, evidence-based home visiting programs in at-risk tribal communities; establish, measure, and report on progress toward meeting performance measures in six legislatively mandated benchmark areas; and participate in rigorous evaluation activities to build the knowledge base on home visiting among Native populations. There are two types of Tribal MIECHV grant programs: Tribal MIECHV Development and Implementation Grants (DIG) and Tribal MIECHV Implementation and Expansion Grants (IEG). In the first year of their grants, Tribal MIECHV DIG and IEG grant recipients must develop an implementation plan on how they will meet the requirements of the program (the Tribal MIECHV Program Implementation Plan Guidance is currently under review at OMB. See ICR Ref No. 202304-0970-002). In years 2-5 of their grants, grantees are required to submit the following reports, which are the focus of this request: • Demographic and Service Utilization Data Report • Performance Measurement Data Report • Quarterly Performance Data Report

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Authorizing Statute(s): PL: Pub.L. 117 - 328 511 Name of Law: Title V of SSA (Maternal and Child Health Services Block Grant)
  

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:
	88 FR 21192	04/10/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 39854	06/20/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Tribal MIECHV Demographic & Service Utilization Data Report (Families)	DSUR	Tribal MIECHV Demographic & Service Utilization Data Report
Tribal MIECHV Demographic & Service Utilization Data Report (Grantees)	DSUR	Tribal MIECHV Demographic & Service Utilization Data Report
Tribal MIECHV Performance Measures Report	PMR	Tribal MIECHV Performance Measures Report
Tribal MIECHV Quarterly Performance Report	QPR	Tribal MIECHV Quarterly Performance Report

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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	2,018	0	0	2,018	0	0
Annual Time Burden (Hours)	34,214	0	0	34,214	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 is a new information collection request.

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Annual Cost to Federal Government: $233,000

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: 06/20/2023

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