Information Collection

Tribal MIECHV Form 1 Demographic and Service Utilization Data and Service

IC 221921 under ICR 201606-0970-002 · OMB 0970-0389.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0389 can be found here:

Documents and Forms

Document Name Document Type
Tribal MIECHV Implementation Plan Guidance FINAL.docx Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Tribal MIECHV Form 1 Demographic and Service Utilization Data and Service	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Tribal MIECHV Implementation Plan Guidance FINAL.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	17	17
Annual IC Time Burden (Hours)	8,333	8,333
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.