(MIECHV MODS) Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) Developing Strategies to Facilitate Cross-Model Collaboration and Data Sharing – Customer Satisfaction Survey Forms

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
Form A (MIECHV MODS) Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) Developing Strategies to Facilitate Cross-Model Collaboration and Data Sharing – Customer Satisfaction Survey Forms Form
A Attachment A - Data Science Training Survey.docx Attachment A - Data Science Training Survey.docx Form
B Attachment B - Resource Guide Survey.docx Attachment B - Resource Guide Survey.docx Form
C Attachment C - List of Analytic Experts Survey.docx Attachment C - List of Analytic Experts Survey.docx Form
MODS Customer Satisfaction Surveys - Supporting Statement.docx SS A IC Document

Information Collection (IC) Details

IC Title:	(MIECHV MODS) Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) Developing Strategies to Facilitate Cross-Model Collaboration and Data Sharing – Customer Satisfaction Survey Forms	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	A	Attachment A - Data Science Training Survey.docx	Attachment A - Data Science Training Survey.docx	Yes	Yes	Fillable Fileable
Form	B	Attachment B - Resource Guide Survey.docx	Attachment B - Resource Guide Survey.docx	Yes	Yes	Fillable Fileable
Form	C	Attachment C - List of Analytic Experts Survey.docx	Attachment C - List of Analytic Experts Survey.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	216	216
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SS A	MODS Customer Satisfaction Surveys - Supporting Statement.docx	02/19/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.