Maternal, Infant, and Early Childhood Home Visiting Needs Assessment Data Summary

The Maternal, Infant, and Early Childhood Home Visiting Program Statewide Needs Assessment Update

Documents and Forms

Document Name Document Type
Appendix A - FY25 NA Amendment RFI.docx Instruction
Appendix A - FY25 NA Amendment RFI.docx Instruction
1 MIECHV Needs Assessment Data Summary_Table 7 Appendix B - MIECHV Needs Assessment Data Summary_Table 7.xlsx Form
1 MIECHV Needs Assessment Data Summary_Table 7 Appendix B - MIECHV Needs Assessment Data Summary_Table 7.xlsx Form

Information Collection (IC) Details

IC Title:	Maternal, Infant, and Early Childhood Home Visiting Needs Assessment Data Summary	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Appendix A - FY25 NA Amendment RFI.docx		Yes	Yes	Fillable Fileable
Form	1	MIECHV Needs Assessment Data Summary_Table 7	Appendix B - MIECHV Needs Assessment Data Summary_Table 7.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	35	35
Annual IC Time Burden (Hours)	1,050	1,050
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.