Information Collection

Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program On-Site Compliance Review Awardee Feedback Form

IC 247472 under ICR 202312-0915-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program On-Site Compliance Review Awardee Feedback Form	Form
1 MIECHV On-Site Compliance Review Awardee Feedback Form_M FORM MIECHV On-Site Compliance Review Awardee Feedback Form_May2021.docx	Form
1 MIECHV On-Site Compliance Review Awardee Feedback Form_M FORM MIECHV On-Site Compliance Review Awardee Feedback Form_May2021.docx	Form
SS A MIECHV onsite Compliance Review Awardee Feedback Form -May 2021.docx SS A MIECHV onsite Compliance Review Awardee Feedback Form -May 2021	IC Document
SS A MIECHV onsite Compliance Review Awardee Feedback Form -May 2021.docx SS A MIECHV onsite Compliance Review Awardee Feedback Form -May 2021	IC Document

IC Title:

Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program On-Site Compliance Review Awardee Feedback Form

Agency IC Tracking Number:

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
Form	1	MIECHV On-Site Compliance Review Awardee Feedback Form_May2021.docx	FORM MIECHV On-Site Compliance Review Awardee Feedback Form_May2021.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 315

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
	Requested	Previously Approved
Annual Number of Responses for this IC	315	315
Annual IC Time Burden (Hours)	79	79
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SS A MIECHV onsite Compliance Review Awardee Feedback Form -May 2021	SS A MIECHV onsite Compliance Review Awardee Feedback Form -May 2021.docx	05/18/2021

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