Information Collection

Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Continuous Quality Improvement (CQI) Practicum Feedback Questions

IC 229636 under ICR 201706-0970-005 · OMB 0970-0401.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CQI Practicum satisfaction survey_wave 2_12 18 17_clean.docx	Other-Survey
Fast Track Generic - Submission Template_CQI Practicum 01-04-18. doc (2).doc Fast Track Submission Form - CQI Practicum satisfaction survey	IC Document

IC Title:

Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Continuous Quality Improvement (CQI) Practicum Feedback Questions

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
Other-Survey			CQI Practicum satisfaction survey_wave 2_12 18 17_clean.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: 65

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	65	65
Annual IC Time Burden (Hours)	22	22
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Submission Form - CQI Practicum satisfaction survey	Fast Track Generic - Submission Template_CQI Practicum 01-04-18. doc (2).doc	01/04/2018

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