Maternal, Infant, and Early Childhood Home Visiting Needs Assessment Data Summary

The Maternal, Infant, and Early Childhood Home Visiting Program Needs Assessment Update Supplemental Information Request

Documents and Forms

Document Name Document Type
Form 1 Maternal, Infant, and Early Childhood Home Visiting Needs Assessment Data Summary Form and Instruction
1 Attachment 1 - MIECHV Needs Assessment Update SIR.pdf Attachment 1 - MIECHV Needs Assessment Update SIR.pdf Form and Instruction
2 Attachment 2 - MIECHV Needs Assessment Data Summary_FINA Attachment 2 - MIECHV Needs Assessment Data Summary_FINAL.XLSX Form and Instruction
Attachment 3 - MIECHV Needs Assessment 60-day FRN.pdf Attachment 3 - MIECHV Needs Assessment 60-day FRN IC Document

Information Collection (IC) Details

IC Title:	Maternal, Infant, and Early Childhood Home Visiting Needs Assessment Data Summary	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 1 - MIECHV Needs Assessment Update SIR.pdf	Attachment 1 - MIECHV Needs Assessment Update SIR.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	Attachment 2 - MIECHV Needs Assessment Data Summary_FINAL.XLSX	Attachment 2 - MIECHV Needs Assessment Data Summary_FINAL.XLSX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	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	51	51
Annual IC Time Burden (Hours)	6,120	6,120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 3 - MIECHV Needs Assessment 60-day FRN	Attachment 3 - MIECHV Needs Assessment 60-day FRN.pdf	08/22/2018

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