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	Modified	Available
Form QPR Tribal MIECHV Quarterly Performance Report	Form and Instruction	Modified	Repair queued
Form PMR Tribal MIECHV Performance Measures Report	Form and Instruction	Unchanged	Available
Form PMR Tribal MIECHV Performance Measures Report	Form and Instruction	Unchanged	Repair queued
Form DSUR Tribal MIECHV Demographic & Service Utilization Data Report	Form and Instruction	Modified	Available
Form DSUR Tribal MIECHV Demographic & Service Utilization Data Report (Families)	Form and Instruction	Modified	Repair queued
Form DSUR Tribal MIECHV Demographic & Service Utilization Data Report	Form and Instruction	Modified	Available
Form DSUR Tribal MIECHV Demographic & Service Utilization Data Report (Grantees)	Form and Instruction	Modified	Repair queued
NonSub Change - Update to ACF ICs - Protecting Women EO - Submission 2.10.25.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-02-10	Available
NonSub Change - Update to ACF ICs - Protecting Women EO - Submission 2.10.25.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-02-10	Repair queued
NonSub Change Request DSUR 7.29.24_fnl.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-07-29	Available
NonSub Change Request DSUR 7.29.24_fnl.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-07-29	Repair queued
THV Reporting Guidance Supporting Statement 6.14.23.docx	Supporting Statement A	Uploaded 2023-06-14	Available
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	Modified	Tribal MIECHV Quarterly Performance Report
260666	Tribal MIECHV Quarterly Performance Report	Form and Instruction	Modified
260665	Tribal MIECHV Performance Measures Report	Form and Instruction	Unchanged	Tribal MIECHV Performance Measures Report
260665	Tribal MIECHV Performance Measures Report	Form and Instruction	Unchanged
260664	Tribal MIECHV Demographic & Service Utilization Data Report (Families)	Form and Instruction	Modified	Tribal MIECHV Demographic & Service Utilization Data Report
260664	Tribal MIECHV Demographic & Service Utilization Data Report (Families)	Form and Instruction	Modified
260663	Tribal MIECHV Demographic & Service Utilization Data Report (Grantees)	Form and Instruction	Modified	Tribal MIECHV Demographic & Service Utilization Data Report
260663	Tribal MIECHV Demographic & Service Utilization Data Report (Grantees)	Form and Instruction	Modified

ICR Details

OMB Control No: 0970-0614	ICR Reference No: 202502-0970-005
Status: Historical Active	Previous ICR Reference No: 202407-0970-011
Agency/Subagency: HHS/ACF	Agency Tracking No: ECD
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: 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: 04/04/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/28/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2026	08/31/2026	08/31/2026
Responses	2,018	0	2,018
Time Burden (Hours)	34,214	0	34,214
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 following ICR has been updated with non substantive changes in response to the Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government Executive Order (Defending Women EO) and recent Presidential Actions related to diversity, equity, and inclusion (DEI), such as those covered under the EO Initial Recissions of Harmful Executive Orders and Actions.

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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	2,018	0	0	0	0
Annual Time Burden (Hours)	34,214	34,214	0	0	0	0
Annual Cost Burden (Dollars)	0	0	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:

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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: 03/28/2025

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