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Federal forms, ICRs, and supporting documents

Information Collection Request

Affordable Care Act Tribal Maternal, Infant, and Early Childhood Home Visiting Program Needs Assessment and Plan for Responding to Identified Needs

ICR 201606-0970-002 · OMB 0970-0389 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 1 Assessment and Plan Form and Instruction Removed Repair queued
THV SUPSTAT_FINAL.HHS 8-10-16.doc Supporting Statement A Uploaded 2016-08-10 Available
IC Document Collections
IC IDCollectionTypeStatusForm
221921 Tribal MIECHV Form 1 Demographic and Service Utilization Data and Service Instruction New
221920 Tribal Maternal, Infant, and Early Childhood Home Visiting Implementation Plan Guidance Instruction New
197233 Assessment and Plan Form and Instruction Removed
ICR Details
0970-0389 201606-0970-002
Historical Active 201104-0970-001
HHS/ACF OCC
Affordable Care Act Tribal Maternal, Infant, and Early Childhood Home Visiting Program Needs Assessment and Plan for Responding to Identified Needs
Reinstatement with change of a previously approved collection   No
Regular
Approved with change 08/15/2016
Retrieve Notice of Action (NOA) 06/15/2016
  Inventory as of this Action Requested Previously Approved
08/31/2019 36 Months From Approved 08/19/2013
25 0 18
16,666 0 1,800
0 0 0
The purpose of the information collection is to receive Tribal MIECHV Program grantees’ needs and readiness assessments and plans for implementation so that they can be reviewed and approved as a condition for program implementation, data collection, and evaluation (Implementation Phase, Years 2-5). The Form 1 data are used to help ACF better understand the population receiving services from Tribal MIECHV grantees and the degree to which they are using services, as well as better understanding of the Tribal MIECHV workforce. Overall, this information collection will provide valuable information to HHS that will guide understanding of Tribal MIECHV grantees and the provision of technical assistance to Tribal MIECHV Program grantees.
PL: Pub.L. 111 - 148 2951 Name of Law: Patient Protection and Affordable Care Act
  
None
Not associated with rulemaking
  80 FR 66008 10/28/2015
81 FR 31641 05/19/2016
No
  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 25 18 0 7 0 0
Annual Time Burden (Hours) 16,666 1,800 0 14,866 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
ACF discression
$0
No
No
Yes
No
No
Uncollected
Robert Sargis 2026907275
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/15/2016