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Tribal Maternal, Infant, and Early Childhood Home Visiting Performance Reporting Form
Tribal Maternal, Infant, and Early Childhood Home Visiting Program Performance Reporting Form 2
OMB: 0970-0500
IC ID: 226874
OMB.report
HHS/ACF
OMB 0970-0500
ICR 202210-0970-002
IC 226874
( )
Documents and Forms
Document Name
Document Type
Form 2
Tribal Maternal, Infant, and Early Childhood Home Visiting Performance Reporting Form
Form
Tribal MIECHV Performance Measures.docx
Instruction
Tribal MIECHV Performance Measures.docx
Instruction
2 Tribal MIECHV Reporting Form 2
Tribal Home Visiting Form 2.docx
Form
2 Tribal MIECHV Reporting Form 2
Tribal Home Visiting Form 2.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Tribal Maternal, Infant, and Early Childhood Home Visiting Performance Reporting Form
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:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
2
Tribal MIECHV Reporting Form 2
Tribal Home Visiting Form 2.docx
Yes
Yes
Fillable Fileable
Instruction
Tribal MIECHV Performance Measures.docx
Yes
Yes
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
23
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
23
0
0
0
0
23
Annual IC Time Burden (Hours)
11,500
0
0
0
0
11,500
Annual IC Cost Burden (Dollars)
0
0
0
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.