Information Collection

Maternal, Infant, and Early Childhood Home Visiting Program Performance Measurement Information System

IC 219429 under ICR 201512-0906-001 · OMB 0906-0017.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0017 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program Performance Measurement Information System Form and Instruction
1 Attachment A - Demographic Performance Measures Attachment A - Demographic Performance Measures_OMB comments_HRSA Response.docx Form and Instruction
2 Attachment B - Benchmark Performance Measures MIECHV_Attachment B - Benchmark Performance Measures MS_OMB Comments_HRSA Response (1).docx Form and Instruction
Attachment G - Crosswalk of Previous and Proposed Benchmark Constructs.docx Attachment G - Crosswalk of Previous and Proposed Benchmark Constructs IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Maternal, Infant, and Early Childhood Home Visiting Program Performance Measurement Information System	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	Attachment A - Demographic Performance Measures	Attachment A - Demographic Performance Measures_OMB comments_HRSA Response.docx		Yes	Yes	Fillable Fileable Signable
Form and Instruction	2	Attachment B - Benchmark Performance Measures	MIECHV_Attachment B - Benchmark Performance Measures MS_OMB Comments_HRSA Response (1).docx		Yes	Yes	Fillable Fileable Signable

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 Agency Discretion
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	47,600	47,600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment G - Crosswalk of Previous and Proposed Benchmark Constructs	Attachment G - Crosswalk of Previous and Proposed Benchmark Constructs.docx	03/04/2016

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