Tribal MIECHV Demographic & Service Utilization Data Report (Grantees)

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 DSUR Tribal MIECHV Demographic & Service Utilization Data Report (Grantees) Form and Instruction
DSUR Tribal MIECHV Demographic & Service Utilization Data Rep THV DSUR Form 2023_FINAL CLEAN 7.29.24.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Tribal MIECHV Demographic & Service Utilization Data Report (Grantees)	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 and Instruction	DSUR	Tribal MIECHV Demographic & Service Utilization Data Report	THV DSUR Form 2023_FINAL CLEAN 7.29.24.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: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	55	55
Annual IC Time Burden (Hours)	17,435	17,435
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.