Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program: Advancing Health Equity in Response to the COVID-19 Public Health Emergency

Documents and Forms

Document Name Document Type
Form 1 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program: Advancing Health Equity in Response to the COVID-19 Public Health Emergency Form and Instruction
1 Community Interview Protocol Attachment A_Community Interview Protocol_06.23.2022.docx Form and Instruction
2 Family Focus Group Guide Attachment B_Family Focus Group Guide_06.23.2022.docx Form
3 Community and Home Visitor Survey Instrument Attachment C_Community and Home Visitor Survey Instrument_06.23.2022.docx Form
4 Program Data Collection Activity Attachment D_Program Data Collection Activity_06.23.2022.docx Form
5 Community Focus Group Guide Attachment E_Community Focus Group Guide_06.23.2022.docx Form

Information Collection (IC) Details

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Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents:	Number of Respondents for Small Entity:

Affected Public:

Percentage of Respondents Reporting Electronically:

		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
Annual IC Time Burden (Hours)
Annual IC Cost Burden (Dollars)

Documents for IC

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