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⚠️ Notice: This information collection may be referencing outdated material.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

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

View Information Collection (IC)

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.