Information Collection

Maternal, Infant, and Early Childhood Home Visiting Program Performance Measurement Information System

IC 219429 under ICR 202503-0906-001 · OMB 0906-0017.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0017 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program Performance Measurement Information System	Form and Instruction
Form 1 0906-0017_MCHB_Indicators Form_Redline 03052025 Maternal, Infant, and Early Childhood Home Visiting Program Performance Measurement Information System	Form and Instruction
Form 2 PERFORMANCE AND SYSTEMS OUTCOME MEASURES Maternal, Infant, and Early Childhood Home Visiting Program Performance Measurement Information System	Form and Instruction
1 0906-0017_MCHB_Indicators Form_Redline 03052025 0906-0017_MCHB_Indicators Form_Redline 03052025.docx	Form and Instruction
1 0906-0017_MCHB_Indicators Form_Redline 03052025 0906-0017_MCHB_Indicators Form_Redline 03052025.docx	Form and Instruction
2 PERFORMANCE AND SYSTEMS OUTCOME MEASURES Appendix B. Form 2 09092024.docx	Form and Instruction
2 PERFORMANCE AND SYSTEMS OUTCOME MEASURES Appendix B. Form 2 09092024.docx	Form and Instruction

IC Title:

Maternal, Infant, and Early Childhood Home Visiting Program Performance Measurement Information System

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:

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				Yes	Yes	Fillable Fileable
Form and Instruction	2				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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	43,736	43,736
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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