Maternal, Infant, and Early Childhood Home Visiting Program: Cost Reporting Tool for Pilot Test in Select Local Implementing Agencies

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0025 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program: Cost Reporting Tool for Pilot Test in Select Local Implementing Agencies Form and Instruction
1 Attachment 1_Cost Tool_FINAL Attachment 1_Cost Tool_FINAL.xlsx Form and Instruction
2 Attachment 2_Pilot Test Questionnaire_FINAL.doc Attachment 2_Pilot Test Questionnaire_FINAL.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Maternal, Infant, and Early Childhood Home Visiting Program: Cost Reporting Tool for Pilot Test in Select Local Implementing Agencies	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	1	Attachment 1_Cost Tool_FINAL	Attachment 1_Cost Tool_FINAL.xlsx		Yes	Yes	Fillable Fileable
Form and Instruction	2	Attachment 2_Pilot Test Questionnaire_FINAL.doc	Attachment 2_Pilot Test Questionnaire_FINAL.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	Number of Respondents for Small Entity: 90

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	90	90
Annual IC Time Burden (Hours)	1,440	1,440
Annual IC Cost Burden (Dollars)	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.