Maternal, Infant, and Early Childhood Home Visiting Program Performance Measurement Information System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4 Quarterly Performance Report	Form and Instruction	New	Available
Form 4 Quarterly Performance Report	Form and Instruction	New	Available
Form 2 Performance Indicators and Systems Outcome Measures	Form and Instruction	Modified	Available
Form 2 Performance Indicators and Systems Outcome Measures	Form and Instruction	Modified	Available
Form 1 Demographic, Service Utilization, Select Clinical Indicators, and Program Locations	Form and Instruction	Modified	Available
Form 1 Demographic, Service Utilization, Select Clinical Indicators, and Program Locations	Form and Instruction	Modified	Available
Supporting Statement A-0906-0017-MCHB-MIECHV Performance Measures 04162026.docx	Supporting Statement A	Uploaded 2026-04-21	Available
Supporting Statement A-0915-0017-MCHB-MIECHV Performance Measures 03062026.docx	Supporting Statement A	Uploaded 2026-03-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
279477	Quarterly Performance Report	Form and Instruction	New	Quarterly Performance Report
279477	Quarterly Performance Report	Form and Instruction	New	Quarterly Performance Report
279477	Quarterly Performance Report	Form and Instruction	New
219429	Annual Reporting: Demographic Service Utilization, Clinical Indicators, and Program Locations; Performance Indicators and Systems Outcome Measures	Form and Instruction	Modified	Performance Indicators and Systems Outcome Measures
219429	Annual Reporting: Demographic Service Utilization, Clinical Indicators, and Program Locations; Performance Indicators and Systems Outcome Measures	Form and Instruction	Modified	Performance Indicators and Systems Outcome Measures
219429	Annual Reporting: Demographic Service Utilization, Clinical Indicators, and Program Locations; Performance Indicators and Systems Outcome Measures	Form and Instruction	Modified	Demographic, Service Utilization, Select Clinical Indicators, and Program Locations
219429	Annual Reporting: Demographic Service Utilization, Clinical Indicators, and Program Locations; Performance Indicators and Systems Outcome Measures	Form and Instruction	Modified	Demographic, Service Utilization, Select Clinical Indicators, and Program Locations
219429	Annual Reporting: Demographic Service Utilization, Clinical Indicators, and Program Locations; Performance Indicators and Systems Outcome Measures	Form and Instruction	Modified

ICR Details

OMB Control No: 0906-0017	ICR Reference No: 202603-0906-002
Status: Active	Previous ICR Reference No: 202503-0906-001
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Maternal, Infant, and Early Childhood Home Visiting Program Performance Measurement Information System
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/01/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/13/2026
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2029	36 Months From Approved	09/30/2027
Responses	280	0	56
Time Burden (Hours)	73,416	0	43,736
Cost Burden (Dollars)	0	0	0

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Abstract: The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program is administered by the Maternal and Child Health Bureau (MCHB) within HRSA in partnership with the Administration for Children and Families. MIECHV provides support to all 56 states and jurisdictions, as well as tribes and tribal organizations. State and jurisdiction MIECHV funding recipients report annual demographic and performance data to HRSA through: Form 1 – Demographic Performance Measures; Form 2 – Benchmark Performance Measures. MIECHV funding recipients also report program information on a quarterly basis through Form 4 – Quarterly Data Collection, currently approved under OMB No. 0906-0016. This ICR will now include Forms 1, 2, and 4, so all the components of data collection for the MIECHV Program in one request. OMB No. 0906-0016 will be discontinued after OMB approval of this ICR. The forms will not be renumbered because MIECHV used to have Form 3 and that is no longer part of the data collection. MCHB decided not to renumber the forms because this has been well recognized by all awardees that it’s the quarterly form and renaming to Form 3 might be more confusing at this time.

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Authorizing Statute(s): US Code: 42 USC 701, section 511 Name of Law: Social Security Act, Sct 511
   PL: Pub.L. 117 - 328 6101 Name of Law: Consolidated Appropriations Act, 2023
  

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:
	90 FR 59844	12/22/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 12431	03/13/2026
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Annual Reporting: Demographic Service Utilization, Clinical Indicators, and Program Locations; Performance Indicators and Systems Outcome Measures	1, 2	Demographic, Service Utilization, Select Clinical Indicators, and Program Locations ,   Performance Indicators and Systems Outcome Measures
Quarterly Performance Report	4	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	280	56	0	224	0	0
Annual Time Burden (Hours)	73,416	43,736	0	29,680	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: Changes have been made to MIECHV Forms 1, 2 and 4. Forms 1 and 2 are included in the currently approved package for OMB No. 0906-0017). Form 4 was approved through a separate ICR: OMB No. 0906-0016. HRSA is seeking to combine all information collection forms through a single ICR in this revision package. However, rather than reflecting a true increase in burden, the updated burden estimate reflects actual burden data more accurately for each form. As stated above in Section 12A, HRSA conducted a survey under OMB No. 0906-0094 in summer 2024 where awardees reported approximate actual burden hours to complete information collection. We are not adjusting the number of the forms to avoid confusion from respondents.

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Annual Cost to Federal Government: $882,628

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: 03/13/2026

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