Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report

The Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report

Documents and Forms

Document Name Document Type
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report Form and Instruction
1 Appendix B. MIECHV Quarterly Report Form 4 Attachment A _MIECHV Form 4 Revised CLEAN.docx Form and Instruction
1 Appendix B. MIECHV Quarterly Report Form 4 Appendix B. MIECHV Quarterly Report Form 4 .docx Form and Instruction

Information Collection (IC) Details

IC Title:	Maternal, Infant, and Early Childhood Home Visiting Program Quarterly Performance Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	Appendix B. MIECHV Quarterly Report Form 4	Appendix B. MIECHV Quarterly Report Form 4 .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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	224	-264	488
Annual IC Time Burden (Hours)	4,704	-14,048	18,752
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.