Information Collection

Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys

IC 247043 under ICR 202103-0915-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 1 Attachment A_Individualized Targeted TA Check in Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys	Form
Form 2 Attachment B_Individualized Targeted TA Closeout Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys	Form
Form 3 Attachment C_Project Officer Survey Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys	Form
Form 4 Attachment D_Webinar Survey Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys	Form
Form 5 Attachment E_Community of Practice Survey Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys	Form
Form 6 Attachment F_Leadership Academy Session Survey Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys	Form
Form 7 Attachment G_Leadership Academy Completion Survey Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys	Form
Form 8 Attachment H_Quarterly Overall TA Survey Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys	Form
Form 9 Attachment I_CQI Practicum Check in Survey Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys	Form
Form 10 Attachment J_CQI Practicum Completion Survey Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys	Form
1 Attachment A_Individualized Targeted TA Check in Attachment A_Individualized Targeted TA Check in.docx	Form
2 Attachment B_Individualized Targeted TA Closeout Attachment B_Individualized Targeted TA Closeout.docx	Form
3 Attachment C_Project Officer Survey Attachment C_Project Officer Survey.docx	Form
4 Attachment D_Webinar Survey Attachment D_Webinar Survey.docx	Form
5 Attachment E_Community of Practice Survey Attachment E_Community of Practice Survey.docx	Form
6 Attachment F_Leadership Academy Session Survey Attachment F_Leadership Academy Session Survey.docx	Form
7 Attachment G_Leadership Academy Completion Survey Attachment G_Leadership Academy Completion Survey.docx	Form
8 Attachment H_Quarterly Overall TA Survey Attachment H_Quarterly Overall TA Survey.docx	Form
9 Attachment I_CQI Practicum Check in Survey Attachment I_CQI Practicum Check in Survey.docx	Form
10 Attachment J_CQI Practicum Completion Survey Attachment J_CQI Practicum Completion Survey.docx	Form
Supporting Statement DHVECS MIECHV TARC Satisfaction Surveys.docx Supporting Statement DHVECS MIECHV TARC Satisfaction Surveys	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Yes	Yes	Fillable Fileable
Form	2	Yes	Yes	Fillable Fileable
Form	3	Yes	Yes	Fillable Fileable
Form	4	Yes	Yes	Fillable Fileable
Form	5	Yes	Yes	Fillable Fileable
Form	6	Yes	Yes	Fillable Fileable
Form	7	Yes	Yes	Fillable Fileable
Form	8	Yes	Yes	Fillable Fileable
Form	9	Yes	Yes	Fillable Fileable
Form	10	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,230

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	2,230	2,230
Annual IC Time Burden (Hours)	209	209
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement DHVECS MIECHV TARC Satisfaction Surveys		04/28/2021

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

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