Information Collection

Tribal MIECHV Demographic & Service Utilization Data Report (Families)

IC 260664 under ICR 202605-0970-002 · OMB 0970-0614.

Documents and Forms

Document Name Document Type
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 Demographic and Service Utilization Data Report.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DSUR	Tribal MIECHV Demographic & Service Utilization Data Report	Demographic and Service Utilization Data Report.docx		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: 2,087	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,087	399	1,688
Annual IC Time Burden (Hours)	17	-372	389
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.

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