Information Collection

Maternal, Infant, and Early Childhood Home Visiting Needs Assessment Data Summary

IC 232798 under ICR 202409-0906-001 · OMB 0906-0038.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 MIECHV Needs Assessment Data Summary_Table 7 Maternal, Infant, and Early Childhood Home Visiting Needs Assessment Data Summary	Form
Appendix A - FY25 NA Amendment RFI.docx	Instruction
Appendix A - FY25 NA Amendment RFI.docx	Instruction
1 MIECHV Needs Assessment Data Summary_Table 7 Appendix B - MIECHV Needs Assessment Data Summary_Table 7.xlsx	Form
1 MIECHV Needs Assessment Data Summary_Table 7 Appendix B - MIECHV Needs Assessment Data Summary_Table 7.xlsx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Instruction					Yes	Yes	Fillable Fileable
Form	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 35

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	35	35
Annual IC Time Burden (Hours)	1,050	1,050
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.

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