Information Collection

Tribal MIECHV Demographic & Service Utilization Data Report (Grantees)

IC 260663 under ICR 202306-0970-007 · OMB 0970-0614.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0614 can be found here:

Documents and Forms

Document Name Document Type
Form DSUR Tribal MIECHV Demographic & Service Utilization Data Report (Grantees) Form and Instruction
DSUR Tribal MIECHV Demographic & Service Utilization Data Rep THV DSUR Form 2023_FINAL 04.10.2023.docx Form and Instruction
DSUR Tribal MIECHV Demographic & Service Utilization Data Rep THV DSUR Form 2023_FINAL 04.10.2023.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Tribal MIECHV Demographic & Service Utilization Data Report (Grantees)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DSUR	Tribal MIECHV Demographic & Service Utilization Data Report	THV DSUR Form 2023_FINAL 04.10.2023.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: 55	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: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	55	55
Annual IC Time Burden (Hours)	17,435	17,435
Annual IC Cost Burden (Dollars)	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.