Information Collection

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

IC 264351 under ICR 202402-0906-004 · OMB 0906-0084.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0084 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 Program On-Site Compliance Review Awardee Feedback Form	Form
1 On Site Compliance Review Awardee Feedback Form FORM MIECHV On-Site Compliance Review Awardee Feedback Form_May202.docx	Form
SS A MIECHV onsite Compliance Review Awardee Feedback Form -Ma.docx Original Generic Request	IC Document

IC Title:

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

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.	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

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	Program Change Due to Agency Discretion
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
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.