Information Collection

Home Visitor Group Interview Protocol

IC 267049 under ICR 202404-0906-005 · OMB 0906-0099.

Documents and Forms

Document Name Document Type
Form 5 Home Visitor Group Interview Protocol Form and Instruction
5 Home Visitor Group Interview Guide Appendix H_Instrument 5_Home Visitor Group Interview Guide.docx Form and Instruction
5 Home Visitor Group Interview Guide Appendix H_Disparities Instrument 5_Home Visitor Group Interview Guide 08012024.docx Form and Instruction
Appendix H_Disparities Instrument 5_Home Visitor Group Interview Guide (RL).docx Appendix H_Disparities Instrument 5_Home Visitor Group Interview Guide (RL) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Home Visitor Group Interview Protocol	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 and Instruction	5	Home Visitor Group Interview Guide	Appendix H_Disparities Instrument 5_Home Visitor Group Interview Guide 08012024.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix H_Disparities Instrument 5_Home Visitor Group Interview Guide (RL)	Appendix H_Disparities Instrument 5_Home Visitor Group Interview Guide (RL).docx	08/01/2024

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