Information Collection

Tribal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Technical Assistance Evaluation (TA) Survey and Immediate Feedback Tool

IC 245928 under ICR 202105-0970-001 · OMB 0970-0401.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A-PATH Technical Assistance Immediate Feedback Form.docx	Other-Feedback Form
Appendix A-PATH Technical Assistance Immediate Feedback Form.docx	Other-Feedback Form
Appendix B-PATH Technical Assistance Evaluation Feedback Form.docx	Other-Feedback Form
Appendix B-PATH Technical Assistance Evaluation Feedback Form.docx	Other-Feedback Form
Fast Track Generic PATH Immediate TA Evaluation Feedback Forms 02-19-2021.docx FastTrack GenIC Submission Form - MIECHV TA Survey and Immediate Feedback Tool	IC Document
Fast Track Generic PATH Immediate TA Evaluation Feedback Forms 02-19-2021.docx FastTrack GenIC Submission Form - MIECHV TA Survey and Immediate Feedback Tool	IC Document

IC Title:

Tribal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Technical Assistance Evaluation (TA) Survey and Immediate Feedback Tool

Agency IC Tracking Number:

OCC

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
Other-Feedback Form			Appendix A-PATH Technical Assistance Immediate Feedback Form.docx		Yes	Yes	Fillable Fileable
Other-Feedback Form			Appendix B-PATH Technical Assistance Evaluation Feedback Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 42

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	42	42
Annual IC Time Burden (Hours)	31	31
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FastTrack GenIC Submission Form - MIECHV TA Survey and Immediate Feedback Tool	Fast Track Generic PATH Immediate TA Evaluation Feedback Forms 02-19-2021.docx	02/19/2021

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