Information Collection

Appendix D_FVL Instrument 1 MIECHV Program FVL Online Survey

IC 267069 under ICR 202404-0906-006 · OMB 0906-0093.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Appendix D_FVL Instrument 1 MIECHV Program FVL Online Survey	Form and Instruction
1 MIECHV Program FVL Online Survey Appendix D_FVL Instrument 1 MIECHV Program FVL Online Survey.docx	Form and Instruction
1 MIECHV Program FVL Online Survey Appendix D_FVL Instrument 1 MIECHV Program FVL Online Survey.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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 and Instruction	1	MIECHV Program FVL Online Survey	Appendix D_FVL Instrument 1 MIECHV Program FVL Online Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 900

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	330	330
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.