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2024 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program All Grantee Meeting Evaluation Surveys
Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration
OMB: 0915-0212
IC ID: 263615
OMB.report
HHS/HSA
OMB 0915-0212
ICR 202312-0915-001
IC 263615
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:
2024-01-10 - Revision of a currently approved collection
2024-01-04 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
2024 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program All Grantee Meeting Evaluation Surveys
Form
1 Conference Evaluation Survey
Instrument A_Conference Evaluation Survey.docx
Form
1 Conference Evaluation Survey
Instrument A_Conference Evaluation Survey.docx
Form
2 Plenary Session Evaluation Survey
Instrument B_Plenary Session Evaluation Survey.docx
Form
2 Plenary Session Evaluation Survey
Instrument B_Plenary Session Evaluation Survey.docx
Form
3 Concurrent Session Evaluation Survey
Instrument C_Concurrent Session Evaluation Survey.docx
Form
3 Concurrent Session Evaluation Survey
Instrument C_Concurrent Session Evaluation Survey.docx
Form
4 AGM Poster Session Evaluation Survey
Instrument D_Poster Session Evaluation Survey.docx
Form
4 AGM Poster Session Evaluation Survey
Instrument D_Poster Session Evaluation Survey.docx
Form
Fast track memo. MIECHV AGM.docx
MIECHV Fast Track Memo 2024
IC Document
Fast track memo. MIECHV AGM.docx
MIECHV Fast Track Memo 2024
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
2024 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program All Grantee Meeting Evaluation Surveys
Agency IC Tracking Number:
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
1
Conference Evaluation Survey
Instrument A_Conference Evaluation Survey.docx
Yes
Yes
Fillable Fileable
Form
2
Plenary Session Evaluation Survey
Instrument B_Plenary Session Evaluation Survey.docx
Yes
Yes
Fillable Fileable
Form
3
Concurrent Session Evaluation Survey
Instrument C_Concurrent Session Evaluation Survey.docx
Yes
Yes
Fillable Fileable
Form
4
AGM Poster Session Evaluation Survey
Instrument D_Poster Session Evaluation Survey.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,960
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
1,960
0
0
0
0
1,960
Annual IC Time Burden (Hours)
102
0
0
0
0
102
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
MIECHV Fast Track Memo 2024
Fast track memo. MIECHV AGM.docx
11/22/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.