Information Collection

Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Feedback Forms

IC 234377 under ICR 201506-0915-001 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form A All Grantee Meeting Feedback Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Feedback Forms	Form
Form B All Grantee Meeting Individual Session Feeback Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Feedback Forms	Form
A All Grantee Meeting Feedback Attachment A - All Grantee Meeting Feedback Form.docx	Form
B All Grantee Meeting Individual Session Feeback Attachment B - All Grantee Meeting Individual Session Feedback Form.docx	Form
Supporting Statement MIECHV AGM Feedback Forms.docx Supporting Statement	IC Document

IC Title:

Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Feedback Forms

Agency IC Tracking Number:

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	A	All Grantee Meeting Feedback	Attachment A - All Grantee Meeting Feedback Form.docx		Yes	Yes	Fillable Fileable
Form	B	All Grantee Meeting Individual Session Feeback	Attachment B - All Grantee Meeting Individual Session Feedback Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,390

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	1,390	1,390
Annual IC Time Burden (Hours)	51	51
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	Supporting Statement MIECHV AGM Feedback Forms.docx	12/03/2018

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