OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Tribal MIECHV Form 1: Demographic and Service Utilization Data and Service

IC 221921 under ICR 202204-0970-021 · OMB 0970-0389.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Tribal MIECHV Form 1: Demographic and Service Utilization Data and Service
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Demographic and Service Utilization Data and Service Tribal MIECHV Form 1 - NonSub 4-29-22 Clean.docx Yes Yes Fillable Fileable

Community and Social Services Social Services

 

23 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 23 0 0 0 0 23
Annual IC Time Burden (Hours) 11,500 0 0 0 0 11,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.