Annual Report

Affordable Care Act Tribal Maternal, Infant, and Early Childhood Home Visiting Guidance

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0409 can be found here:

Documents and Forms

Document Name Document Type
2015-Tribal MIECHV Guidance for Submitting an Annual or Final Report to the Secretary FINAL.docx Instruction
Tribal MIECHV Guidance for Submitting an Annual Report to the Secretary OMB 0970-0409.pdf Tribal MIECHV Guidance for Submitting an Annual Report to the Secretary IC Document

Information Collection (IC) Details

IC Title:	Annual Report	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
Instruction			2015-Tribal MIECHV Guidance for Submitting an Annual or Final Report to the Secretary FINAL.docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	1,250	1,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Tribal MIECHV Guidance for Submitting an Annual Report to the Secretary	Tribal MIECHV Guidance for Submitting an Annual Report to the Secretary OMB 0970-0409.pdf	05/27/2015

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