Tribal MIECHV Performance Measures Report

Tribal Maternal, Infant, and Early Childhood Home Visiting Program Data Reports: Demographic and Service Utilization, Grantee Performance Measures and Quarterly Performance Reports

Documents and Forms

Document Name Document Type
Form PMR Tribal MIECHV Performance Measures Report Form and Instruction
PMR Tribal MIECHV Performance Measures Report THV PMR Form 2023_FINAL 04.10.2023.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Tribal MIECHV Performance Measures Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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 and Instruction	PMR	Tribal MIECHV Performance Measures Report	THV PMR Form 2023_FINAL 04.10.2023.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: 55	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	55	55
Annual IC Time Burden (Hours)	15,840	15,840
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.