Generic for ACF Program Monitoring Activities

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Payment Management Reconciliation Instrument	Form	Unchanged	Available
Form 1 Office of Head Start Improper Payment Reviews – Update 2023	Form	Unchanged	Repair queued
Form 1 LIHWAP Forecast	Form	Unchanged	Available
Form 1 Low Income Household Water Assistance Program (LIHWAP) Grantee Forecast	Form	Unchanged	Repair queued
Form 1 Survivors of Torture (SOT) Integrated Care Continuum (ICC)	Form and Instruction	Unchanged	Available
Form 1 Survivors of Torture Integrated Care Continuum (SOT-ICC)	Form and Instruction	Unchanged	Repair queued
Form M-16 Annual Data Collection on Sexual Abuse and Sexual Harassment Involving UC	Form	Unchanged	Available
Form M-16 Annual Data Collection on Sexual Abuse and Sexual Harassment Involving Unaccompanied Children	Form	Unchanged	Repair queued
Form M-11P Staff Questionnaire - Interpreter Questionnaire	Form	Unchanged	Available
Form M-11P Office of Refugee Resettlement's Staff Questionnaire - Interpreter	Form	Unchanged	Repair queued
Form 1 Disaster Supplement Payment Management Reconciliation Example	Form	Unchanged	Available
Form 1 Office of Head Start Disaster Recovery Improper Payment Reviews	Form	Unchanged	Repair queued
Form 1 Document Request List	Form and Instruction	Unchanged	Available
Form 1 Office of Grants Management Financial Monitoring Review	Form and Instruction	Unchanged	Repair queued
Change Request ECSH 6_23 updated_cln.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-06-27	Repair queued
Change Request ECSH 6_23 updated_cln.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-06-27	Repair queued
Change Request - ORR PSA Data Collection_Monitoring GenIC_6.5.23.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-06-05	Available
Change Request - ORR PSA Data Collection_Monitoring GenIC_6.5.23.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-06-05	Repair queued
Change Request RFCCMED 4 23.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-04-24	Available
Change Request RFCCMED 4 23.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-04-24	Repair queued
Change Request RCP 4 23.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-04-19	Available
Change Request RCP 4 23.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-04-19	Repair queued
GenIC Example - Monitoring Activities - Regulation compliance.docx	Supplementary Document	Uploaded 2020-09-10	Repair queued
GenIC Example - Monitoring Activities - Regulation compliance.docx	Supplementary Document	Uploaded 2020-09-10	Repair queued
GenIC Example - Monitoring Activities - Document Submission.docx	Supplementary Document	Uploaded 2020-09-10	Available
GenIC Example - Monitoring Activities - Document Submission.docx	Supplementary Document	Uploaded 2020-09-10	Repair queued
GenIC Example - Monitoring Activities - Daily Activities.docx	Supplementary Document	Uploaded 2020-09-10	Available
GenIC Example - Monitoring Activities - Daily Activities.docx	Supplementary Document	Uploaded 2020-09-10	Repair queued
GenIC Example - Monitoring Activities - Assessment Survey.docx	Supplementary Document	Uploaded 2020-09-10	Available
GenIC Example - Monitoring Activities - Assessment Survey.docx	Supplementary Document	Uploaded 2020-09-10	Repair queued
Submission Template for Monitoring Generic _7.3.20.docx	Supplementary Document	Uploaded 2020-09-10	Available
Submission Template for Monitoring Generic _7.3.20.docx	Supplementary Document	Uploaded 2020-09-10	Repair queued
SSA - ACF Generic for Monitoring - Final.docx	Supporting Statement A	Uploaded 2020-09-10	Available
SSA - ACF Generic for Monitoring - Final.docx	Supporting Statement A	Uploaded 2020-09-10	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
261246	Office of Refugee Resettlement Refugee Career Pathways Case File Requirements	Other-Questionnaire	New
261245	Office of Refugee Resettlement Refugee Microenterprise Development Case File Requirements	Other-Questionnaire	New
261244	Office of Refugee Resettlement Ethnic Community Self-Help (ECSH) Program Pre-Monitoring Questionnaire (PMQ)	Other-Questionnaire	New
261233	Office of Refugee Resettlement Refugee Individual Development Accounts Program Pre-Monitoring Questionnaire	Other-Questionnaire	New
260914	Office of Head Start Survey on COVID-19 Mitigation Plan	Other-Survey	New
260658	Community Services Block Grant (CSBG) Work Plan Template	Other-Template	Unchanged
259658	Office of Head Start Improper Payment Reviews – Update 2023	Form	Unchanged	Payment Management Reconciliation Instrument
259658	Office of Head Start Improper Payment Reviews – Update 2023	Form	Unchanged
257727	Monitoring the Status of Required Licensure	Other-Instructions	Unchanged
256922	Low Income Household Water Assistance Program (LIHWAP) Grantee Forecast	Form	Unchanged	LIHWAP Forecast
256922	Low Income Household Water Assistance Program (LIHWAP) Grantee Forecast	Form	Unchanged
256922	Low Income Household Water Assistance Program (LIHWAP) Grantee Forecast	Instruction	Unchanged
256016	Survivors of Torture Integrated Care Continuum (SOT-ICC)	Form and Instruction	Unchanged	Survivors of Torture (SOT) Integrated Care Continuum (ICC)
256016	Survivors of Torture Integrated Care Continuum (SOT-ICC)	Form and Instruction	Unchanged
255384	Office of Head Start Survey on Background Checks and Staffing	Other-Survey	Unchanged
254691	Low Income Household Water Assistance Program (LIHWAP) Tribal Implementation Check-In	Other-Interview Qs	Unchanged
254180	Office of Refugee Resettlement (ORR) Ethnic Community Self-Help (ECSH) Program Case Documentation Requirements	Instruction	Modified
252566	Office of Refugee Resettlement (ORR) Refugee Agricultural Partnership Program (RAPP) Case File Requirements	Instruction	Unchanged
252558	Office of Refugee Resettlement (ORR) Refugee Individual Development Accounts (IDA) Program Case File Requirements	Instruction	Unchanged
252424	Office of Refugee Resettlement Refugee Family Child Care Microenterprise Development File Requirements	Instruction	Unchanged
252423	Office of Refugee Resettlement Refugee Career Pathways Case File Requirements	Instruction	Unchanged
252410	Office of Refugee Resettlement (ORR) Refugee Microenterprise Development (MED) Program Case File Requirements	Instruction	Unchanged
251144	Annual Data Collection on Sexual Abuse and Sexual Harassment Involving Unaccompanied Children	Form	Unchanged	Annual Data Collection on Sexual Abuse and Sexual Harassment Involving UC
251144	Annual Data Collection on Sexual Abuse and Sexual Harassment Involving Unaccompanied Children	Form	Unchanged
250729	Office of Refugee Resettlement's Staff Questionnaire - Interpreter	Form	Unchanged	Staff Questionnaire - Interpreter Questionnaire
250729	Office of Refugee Resettlement's Staff Questionnaire - Interpreter	Form	Unchanged
249725	Office on Trafficking in Persons (OTIP) Grant Monitoring Tool (GMT)	Other-Monitoring Tool	Unchanged
249675	Child Care and Development Fund (CCDF) State Monitoring Compliance Demonstration Packet	Other-Monitoring Packet	Unchanged
248146	Office of Refugee Resettlement Waiver Request Form	Other-Request Form	Unchanged
248125	Office of Refugee Resettlement Key Personnel Minimum Qualification Checklist and Attestation	Other-Checklist	Unchanged
245964	Office of Head Start Disaster Recovery Improper Payment Reviews	Form	Unchanged	Disaster Supplement Payment Management Reconciliation Example
245964	Office of Head Start Disaster Recovery Improper Payment Reviews	Form	Unchanged
245964	Office of Head Start Disaster Recovery Improper Payment Reviews	Instruction	Unchanged
244986	Office of Grants Management Financial Monitoring Review	Form and Instruction	Unchanged	Document Request List
244986	Office of Grants Management Financial Monitoring Review	Form and Instruction	Unchanged
244986	Office of Grants Management Financial Monitoring Review	Other-Questionnaire	Unchanged

ICR Details

OMB Control No: 0970-0558	ICR Reference No: 202306-0970-012
Status: Historical Active	Previous ICR Reference No: 202306-0970-002
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Generic for ACF Program Monitoring Activities
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/29/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/27/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2023	11/30/2023	11/30/2023
Responses	4,500	0	4,500
Time Burden (Hours)	45,000	0	45,000
Cost Burden (Dollars)	2,184,300	0	2,184,300

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Abstract: This information collection request (ICR) is for a new overarching generic clearance. The proposed Generic for ACF Program Monitoring Activities would allow Administration for Children and Families (ACF) program offices to collect standardized information from recipients that receive Federal funds to ensure oversight, evaluation, support purposes, and stewardship of Federal funds. The information is necessary to ensure compliance with Federal and programmatic requirements, monitor progress on recipient activities, and determine and respond to recipient needs such as Training and Technical Assistance (T/TA).

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Authorizing Statute(s): None

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:
	85 FR 41241	07/09/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 55461	09/08/2020
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 26

table that charts list of burden

IC Title	Form No.	Form Name
Annual Data Collection on Sexual Abuse and Sexual Harassment Involving Unaccompanied Children	M-16	Annual Data Collection on Sexual Abuse and Sexual Harassment Involving UC
Child Care and Development Fund (CCDF) State Monitoring Compliance Demonstration Packet
Community Services Block Grant (CSBG) Work Plan Template
Low Income Household Water Assistance Program (LIHWAP) Grantee Forecast	1	LIHWAP Forecast
Low Income Household Water Assistance Program (LIHWAP) Tribal Implementation Check-In
Monitoring the Status of Required Licensure
Office of Grants Management Financial Monitoring Review	1	Document Request List
Office of Head Start Disaster Recovery Improper Payment Reviews	1	Disaster Supplement Payment Management Reconciliation Example
Office of Head Start Improper Payment Reviews – Update 2023	1	Payment Management Reconciliation Instrument
Office of Head Start Survey on Background Checks and Staffing
Office of Head Start Survey on COVID-19 Mitigation Plan
Office of Refugee Resettlement (ORR) Ethnic Community Self-Help (ECSH) Program Case Documentation Requirements
Office of Refugee Resettlement (ORR) Refugee Agricultural Partnership Program (RAPP) Case File Requirements
Office of Refugee Resettlement (ORR) Refugee Individual Development Accounts (IDA) Program Case File Requirements
Office of Refugee Resettlement (ORR) Refugee Microenterprise Development (MED) Program Case File Requirements
Office of Refugee Resettlement Ethnic Community Self-Help (ECSH) Program Pre-Monitoring Questionnaire (PMQ)
Office of Refugee Resettlement Key Personnel Minimum Qualification Checklist and Attestation
Office of Refugee Resettlement Refugee Career Pathways Case File Requirements
Office of Refugee Resettlement Refugee Career Pathways Case File Requirements
Office of Refugee Resettlement Refugee Family Child Care Microenterprise Development File Requirements
Office of Refugee Resettlement Refugee Individual Development Accounts Program Pre-Monitoring Questionnaire
Office of Refugee Resettlement Refugee Microenterprise Development Case File Requirements
Office of Refugee Resettlement Waiver Request Form
Office of Refugee Resettlement's Staff Questionnaire - Interpreter	M-11P	Staff Questionnaire - Interpreter Questionnaire
Office on Trafficking in Persons (OTIP) Grant Monitoring Tool (GMT)
Survivors of Torture Integrated Care Continuum (SOT-ICC)	1	Survivors of Torture (SOT) Integrated Care Continuum (ICC)

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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	4,500	4,500	0	0	0	0
Annual Time Burden (Hours)	45,000	45,000	0	0	0	0
Annual Cost Burden (Dollars)	2,184,300	2,184,300	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This request is for a new overarching generic clearance.

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Annual Cost to Federal Government: $200,000

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: 06/27/2023

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