Information Collection

Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Feedback Forms

IC 234377 under ICR 202012-0915-001 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form A Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Feedback Forms	Form
A All Grantee Meeting Feedback Attachment A - All Grantee Meeting Feedback Form.docx	Form
B All Grantee Meeting Individual Session Feeback Attachment B - All Grantee Meeting Individual Session Feedback Form.docx	Form
Supporting Statement MIECHV AGM Feedback Forms.docx Supporting Statement	IC Document

IC Title:

Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Feedback Forms

Agency IC Tracking Number:

IC Status: Unchanged

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	A	All Grantee Meeting Feedback	Attachment A - All Grantee Meeting Feedback Form.docx		Yes	Yes	Fillable Fileable
Form	B	All Grantee Meeting Individual Session Feeback	Attachment B - All Grantee Meeting Individual Session Feedback Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,390

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
	Requested	Previously Approved
Annual Number of Responses for this IC	1,390	1,390
Annual IC Time Burden (Hours)	51	51
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	Supporting Statement MIECHV AGM Feedback Forms.docx	12/03/2018

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