Information Collection

Home Visiting Budget Assistance Tool

IC 223574 under ICR 202001-0906-001 · OMB 0906-0025.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0025 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Home Visiting Budget Assistance Tool	Form and Instruction
1 HVBAT_FINAL_Revised 03.05.2020.xlsx HVBAT_FINAL_Revised 03.05.2020.xlsx	Form and Instruction

IC Title:

Home Visiting Budget Assistance Tool

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	1	HVBAT_FINAL_Revised 03.05.2020.xlsx	HVBAT_FINAL_Revised 03.05.2020.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 19

Number of Respondents for Small Entity: 19

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	247	157	90
Annual IC Time Burden (Hours)	4,446	3,006	1,440
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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