Information Collection

Administrative Burden Assessment State and Jurisdiction MIECHV Funding Recipients

IC 265795 under ICR 202403-0906-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Administrative Burden Assesments	Form and Instruction
1 Administrative Burden Assessment for State and Jurisdict Appendix E. Administrative Burden Assessment for State and Jurisdiction MIECHV Funding Recipients.docx	Form and Instruction
1 Administrative Burden Assessment for State and Jurisdict Appendix E MIECHV Funding Recipients.docx	Form and Instruction
2 Administrative Burden Assessments for Tribal MIECHV Gran Appendix F. Administrative Burden Assessment for Tribal MIECHV Grant Recipients.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	1	Administrative Burden Assessment for State and Jurisdiction MIECHV Funding Recipients	Appendix E MIECHV Funding Recipients.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

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	56	56
Annual IC Time Burden (Hours)	1,512	1,512
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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