Information Collection

Appendix F_FVL Instrument 3 MIECHV Lead Interview Guide

IC 267071 under ICR 202404-0906-006 · OMB 0906-0093.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Appendix F_FVL Instrument 3 MIECHV Lead Interview Guide	Form and Instruction
3 MIECHV Lead Interview Guide Appendix F_FVL Instrument 3 MIECHV Lead Interview Guide.docx	Form and Instruction
3 MIECHV Lead Interview Guide Appendix F_FVL Instrument 3 MIECHV Lead Interview Guide.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	3	MIECHV Lead Interview Guide	Appendix F_FVL Instrument 3 MIECHV Lead Interview Guide.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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