Maternal, Infant, and Early Childhood Home Visiting Program FY 2012 Competitive Noncompeting Continuation Progress Reports (X02)

Forms and Documents

Document Name	Status
Form 1 progress report on FY11 activities final 4.5.12 Form and Instruction	Modified
HHRSAResponseFINAL0915-0355 RevisedSupporting Stmt.docx Supporting Statement A	2015-11-10

IC Document Collections

IC ID	Document Title	Status
203697	progress report on FY11 activities final 4.5.12 Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0355	ICR Reference No: 201509-0915-001
Status: Historical Active	Previous ICR Reference No: 201208-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Maternal, Infant, and Early Childhood Home Visiting Program FY 2012 Competitive Noncompeting Continuation Progress Reports (X02)
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: 11/10/2015
	Date Received in OIRA: 09/16/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2018	36 Months From Approved	11/30/2015
Responses	56	0	56
Time Burden (Hours)	2,352	0	2,352
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection is needed for grantees to report progress under the Home Visiting Program annually. The information collected will be used to review grantee progress on proposed project plans to assess whether the project is performing adequately to achieve goals and objectives that were previously approved. The respondents will be grantees with Home Visiting Formula Awards.

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Authorizing Statute(s): US Code: 42 USC 711 Name of Law: Social Security Act Title V
   PL: Pub.L. 111 - 148 2951 Name of Law: Patient Protection Affordable Care Act
  

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:
	77 FR 92	04/16/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 178	09/15/2015
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
progress report on FY11 activities final 4.5.12	1	Formula Grant Award Progress Report

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ICR Summary 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	56	56	0	0	0	0
Annual Time Burden (Hours)	2,352	2,352	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: $13,020

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

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? Uncollected

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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: 09/16/2015

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