Information Collection

Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys

IC 264348 under ICR 202401-0915-004 · OMB 0915-0212.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Form 1 Annual Awardee Survey Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Form 2 Instrument B_Post Webinar Survey Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Form 3 Post Learning Collaborative Survey Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form and Instruction
1 Annual Awardee Survey Instrument A_Annual Awardee Survey.docx	Form
1 Annual Awardee Survey Instrument A_Annual Awardee Survey.docx	Form
2 Instrument B_Post Webinar Survey Instrument B_Post Webinar Survey.docx	Form
2 Instrument B_Post Webinar Survey Instrument B_Post Webinar Survey.docx	Form
3 Post Learning Collaborative Survey Instrument C_Post Learning Collaborative Survey.docx	Form and Instruction
3 Post Learning Collaborative Survey Instrument C_Post Learning Collaborative Survey.docx	Form and Instruction
Fast track memo.ITAC Satisfaction Surveys.docx Original Generic Request	IC Document
Fast track memo.ITAC Satisfaction Surveys.docx Original Generic Request	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Yes	Yes	Fillable Fileable
Form	2	Yes	Yes	Fillable Fileable
Form and Instruction	3	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 665

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	665	665
Annual IC Time Burden (Hours)	70	70
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Original Generic Request		01/09/2024

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

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