Information Collection

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

IC 232798 under ICR 201808-0906-001 · OMB 0906-0038.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0038 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.