Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report

The Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0016 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report Form and Instruction
Attachment A _MIECHV Form 4 TRACKED.docx Other-Tracked Changes
Attachment A _MIECHV Form 4 TRACKED.docx Other-Tracked Changes
1 MIECHV Form 4 Revised CLEAN.docx Attachment A _MIECHV Form 4 Revised CLEAN.docx Form and Instruction
1 MIECHV Form 4 Revised CLEAN.docx Attachment A _MIECHV Form 4 Revised CLEAN.docx Form and Instruction
1 Updated Attachment A _MIECHV Form 4 Revised Updates 11-22-21.doc Attachment A _MIECHV Form 4 Revised_updates.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	MIECHV Form 4 Revised CLEAN.docx	Attachment A _MIECHV Form 4 Revised CLEAN.docx	Yes	Yes	Fillable Fileable
Other-Tracked Changes			Attachment A _MIECHV Form 4 TRACKED.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1 Updated	Attachment A _MIECHV Form 4 Revised Updates 11-22-21.docx	Attachment A _MIECHV Form 4 Revised_updates.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	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	Previously Approved
Annual Number of Responses for this IC	488	224	264
Annual IC Time Burden (Hours)	18,752	5,376	13,376
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.