Information Collection

2013 527 CMS MAC Questionniare - 2013 528 HRSA MCHB - MIECHV Questionnaire

IC 207219 under ICR 201209-1090-001 · OMB 1090-0007.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0007 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 527 2013 527 CMS MAC Questionniare - 2013 528 HRSA MCHB - MIECHV Questionnaire	Form and Instruction
527 2013 527 CMS MAC Questionnaire FINAL 2013 527 CMS MAC Questionnaire FINAL.docx	Form and Instruction
528 2013 528 HRSA MCHB - MIECHV Questionnaire 2013 528 HRSA MCHB - MIECHV Questionnaire - 10.0.docx	Form and Instruction

IC Title:

2013 527 CMS MAC Questionniare - 2013 528 HRSA MCHB - MIECHV Questionnaire

Agency IC Tracking Number:

527 - 528

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	527	2013 527 CMS MAC Questionnaire FINAL	2013 527 CMS MAC Questionnaire FINAL.docx		Yes	Yes	Fillable Fileable
Form and Instruction	528	2013 528 HRSA MCHB - MIECHV Questionnaire	2013 528 HRSA MCHB - MIECHV Questionnaire - 10.0.docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	700	700
Annual IC Time Burden (Hours)	292	292
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.