Information Collection

Supplemental Information Request for the Submission of the Updated State Plan for A State Home Visiting Program

IC 196112 under ICR 201102-0915-001 · OMB 0915-0336.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0336 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Supplemental Information Request for the Submission of the Updated State Plan for A State Home Visiting Program Form and Instruction
1 SIR SIR- Updated State Plan FINAL 11 19 4 50 pm (2).docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Supplemental Information Request for the Submission of the Updated State Plan for A State Home Visiting Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	SIR	SIR- Updated State Plan FINAL 11 19 4 50 pm (2).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	15,176	15,176
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.