Information Collection

Tribal MIECHV Demographic & Service Utilization Data Report (Families)

IC 260664 under ICR 202502-0970-005 · OMB 0970-0614.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0614 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DSUR Tribal MIECHV Demographic & Service Utilization Data Report (Families)	Form and Instruction
Form DSUR Tribal MIECHV Demographic & Service Utilization Data Report Tribal MIECHV Demographic & Service Utilization Data Report (Families)	Form and Instruction
DSUR Tribal MIECHV Demographic & Service Utilization Data Rep THV DSUR Form Updated 2.21.25 (Final Revision)_clean.docx	Form and Instruction
DSUR Tribal MIECHV Demographic & Service Utilization Data Rep THV DSUR Form Updated 2.21.25 (Final Revision)_clean.docx	Form and Instruction

IC Title:

Tribal MIECHV Demographic & Service Utilization Data Report (Families)

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
Form and Instruction	DSUR				Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,688

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,688	1,688
Annual IC Time Burden (Hours)	389	389
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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