Request for Certification of Adult Victims of Human Trafficking

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Request for HHS Certification of Foreign National Adult Victims of Human Trafficking	Form	Modified	Repair queued
Form 1 Request for Certification of Foreign National Adult Victims of Human Trafficking	Form	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	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	Missing upstream
RFC SSA_4.18.22_Clean_SexChangePreRenewal.docx	Supporting Statement A	Uploaded 2025-03-03	Repair queued
RFC SSA_4.18.22_Clean.docx	Supporting Statement A	Uploaded 2022-04-18	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
215217	Request for Certification of Foreign National Adult Victims of Human Trafficking	Form	Modified	Request for HHS Certification of Foreign National Adult Victims of Human Trafficking
215217	Request for Certification of Foreign National Adult Victims of Human Trafficking	Form	Modified
215217	Request for Certification of Foreign National Adult Victims of Human Trafficking	Instruction	Modified

ICR Details

OMB Control No: 0970-0454	ICR Reference No: 202502-0970-020
Status: Historical Active	Previous ICR Reference No: 202201-0970-008
Agency/Subagency: HHS/ACF	Agency Tracking No: OTIP
Title: Request for Certification of Adult Victims of Human Trafficking
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 with change	Conclusion Date: 03/03/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/15/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2025	04/30/2025	04/30/2025
Responses	433	0	433
Time Burden (Hours)	433	0	433
Cost Burden (Dollars)	0	0	0

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Abstract: The U.S. Department of Health and Human Services (HHS) provides letters of certification to foreign national victims of severe forms of trafficking in persons under the authority of the Trafficking Victims Protection Act of 2000 (TVPA), as amended 22 U.S.C. Section 7105(b)(1)(C) and (E). HHS delegated this authority to the Administration for Children and Families (ACF) Office of Trafficking in Persons (OTIP). Certification is required for foreign national adult victims of human trafficking in the United States to apply for federally funded benefits and services. OTIP developed a form for potential victims and their advocates, including case managers, attorneys, law enforcement officers, service providers, and other representatives to provide the required information for certification to HHS in accordance with the TVPA of 2000, as amended. The Request for Certification of Adult Victims of Human Trafficking (RFC) form (formerly titled Trafficking Victims Tracking System) was renamed in order to create consistency between the RFC and Request for Assistance for Child Victims of Human Trafficking (RFA) forms (OMB Control Number 0970-0362). ACF has implemented changes to update gender collected data to denote sex as a biological variable in current approved information collection requests to comply with recent presidential directives.

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Authorizing Statute(s): US Code: 22 USC 7105 Name of Law: Trafficking Victims Protection Act of 2000, as amended
  

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:
	86 FR 61276	11/05/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 4033	01/26/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Request for Certification of Foreign National Adult Victims of Human Trafficking	1	Request for HHS Certification of Foreign National Adult Victims of Human Trafficking

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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	433	433	0	0	0	0
Annual Time Burden (Hours)	433	433	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: $45,370

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.     Yes

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: 02/15/2025

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