Home Visiting Assessment of Implementation Quality Study: Better Addressing Disparities Through Home Visiting

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Request for LIA	Form and Instruction	New	Available
Form 1 Request for Information about LIAs	Form and Instruction	New	Repair queued
Form 2 LIA Leadership Interview Protocol	Form and Instruction	New	Available
Form 2 LIA Leadership Protocol	Form and Instruction	New	Repair queued
Form 6 LIA and Family Nomination Form	Form and Instruction	New	Available
Form 6 Local Implementing Agency and Family Nomination Form	Form and Instruction	New	Repair queued
Form 5 Home Visitor Group Interview Guide	Form and Instruction	New	Available
Form 5 Home Visitor Group Interview Protocol	Form and Instruction	New	Repair queued
Form 4 Family Focus Group Protocol	Form and Instruction	New	Available
Form 4 Family Focus Group Protocol	Form and Instruction	New	Repair queued
Form 3 Family Online Survey	Form and Instruction	New	Available
Form 3 Family Online Survey	Form and Instruction	New	Repair queued
Supporting Statement A- HV-AIM- MCHB- New- 4.25.docx	Supporting Statement A	Uploaded 2024-04-25	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
267256	Request for Information about LIAs	Form and Instruction	New	Request for LIA
267256	Request for Information about LIAs	Form and Instruction	New
267253	LIA Leadership Protocol	Form and Instruction	New	LIA Leadership Interview Protocol
267253	LIA Leadership Protocol	Form and Instruction	New
267243	Local Implementing Agency and Family Nomination Form	Form and Instruction	New	LIA and Family Nomination Form
267243	Local Implementing Agency and Family Nomination Form	Form and Instruction	New
267049	Home Visitor Group Interview Protocol	Form and Instruction	New	Home Visitor Group Interview Guide
267049	Home Visitor Group Interview Protocol	Form and Instruction	New
267047	Family Focus Group Protocol	Form and Instruction	New	Family Focus Group Protocol
267047	Family Focus Group Protocol	Form and Instruction	New
267045	Family Online Survey	Form and Instruction	New	Family Online Survey
267045	Family Online Survey	Form and Instruction	New

ICR Details

OMB Control No: 0906-0099	ICR Reference No: 202404-0906-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Home Visiting Assessment of Implementation Quality Study: Better Addressing Disparities Through Home Visiting
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 with change	Conclusion Date: 08/01/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/25/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2027	36 Months From Approved
Responses	416	0	0
Time Burden (Hours)	311	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: HRSA aims to explore how families that experience disparities in outcomes targeted by the MIECHV program experience home visiting services. This study is an initial step in understanding those experiences and will provide a better understanding of how MIECHV-funded home visiting programs currently address disparities and promote equity. Data collection activities include interviews, focus groups, online surveys, program observations, and review of documents and management information systems data.

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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:
	88 FR 84341	12/05/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 23030	04/03/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Family Focus Group Protocol	4	Family Focus Group Protocol
Family Online Survey	3	Family Online Survey
Home Visitor Group Interview Protocol	5	Home Visitor Group Interview Guide
LIA Leadership Protocol	2	LIA Leadership Interview Protocol
Local Implementing Agency and Family Nomination Form	6	LIA and Family Nomination Form
Request for Information about LIAs	1	Request for LIA

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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	416	0	0	416	0	0
Annual Time Burden (Hours)	311	0	0	311	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: Inputting form numbers

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Annual Cost to Federal Government: $337,432

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 04/25/2024

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