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

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

OMB: 0915-0212

IC ID: 264351

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Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 On Site Compliance Review Awardee Feedback Form FORM MIECHV On-Site Compliance Review Awardee Feedback Form_May202.docx Yes Yes Fillable Fileable

Health Health Care Services

 

315 0
   
State, Local, and Tribal Governments
 
   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 315 0 315 0 0 0
Annual IC Time Burden (Hours) 79 0 79 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Original Generic Request SS A MIECHV onsite Compliance Review Awardee Feedback Form -Ma.docx 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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