Child and Family Outcome Survey and Updating Contact Information

Mother and Infant Home Visiting Program Evaluation (MIHOPE)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0402 can be found here:

Documents and Forms

Document Name Document Type
Attachment 3_MIHOPE Check-in 2.5 year old Assessment_revised_UPDATED August 2015.docx Other-Check-In
MIHOPE Check-in_3.5 year old Assessment_Attachment 2_clean 3.11.16.docx Other-Check-in
MIHOPE Check-in_3.5 year old Assessment_Attachment 1_track changes 3.11.16.docx 3.5 year old Assessment - Track changes to show updates from 2.5 yo version IC Document

Information Collection (IC) Details

IC Title:	Child and Family Outcome Survey and Updating Contact Information	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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
Other-Check-In			Attachment 3_MIHOPE Check-in 2.5 year old Assessment_revised_UPDATED August 2015.docx		Yes	Yes	Fillable Fileable
Other-Check-in			MIHOPE Check-in_3.5 year old Assessment_Attachment 2_clean 3.11.16.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,433	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	4,299	4,299
Annual IC Time Burden (Hours)	2,150	2,150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
3.5 year old Assessment - Track changes to show updates from 2.5 yo version	MIHOPE Check-in_3.5 year old Assessment_Attachment 1_track changes 3.11.16.docx	03/18/2016

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