Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Home Visitor Survey Baseline New 170 213 0 Other-Survey
Supervisor Survey 12 Month New 33 41 0 Other-Survey
Community Service Provider Survey New 510 51 0 Other-Survey
Family Baseline Survey New 1700 1700 0 Other-Survey
Family Screening and Consent New 1889 189 0 Other-Screener
First Round Visits with State Administrators Modified 18 27 0 Other-Site Visits
Home Visitor Group Interview 12 Month New 87 131 0 Other-Interview
Home Visitor Individual Interview 12 Month New 87 131 0 Other-Interview
Home Visitor Logs New 10200 2040 0 Other-Logs
Home Visitor Survey 12 Month New 170 213 0 Other-Survey
Other Home Visiting Programs Survey New 142 14 0 Other-Survey
Program Manager Group Interview 12 Month New 29 44 0 Other-Interview
Program Manager Survey 12 Month New 29 58 0 Other-Survey
Program Manager Survey_Part 1 Baseline New 29 15 0 Other-Survey
Program Manager Survey_Part 2 Baseline New 29 29 0 Other-Survey
Program Manager Survey_Part 3 Baseline New 29 29 0 Other-Survey
Second Round Visits with State Administrators Modified 15 23 0 Other-Site Visits
State Administrator Interview 12 Month New 8 16 0 Other-Interview
State Administrator Interview Baseline New 8 16 0 Other-Interview
Supervisor Group Interview 12 Month New 33 50 0 Other-Interview
Supervisor Logs New 1980 396 0 Other-Logs
Supervisor Survey Baseline New 33 41 0 Other-Survey
Telephone contact with state administrators Modified 49 49 0 Other-Telephone Contact
Visits and Calls with Local Program Directors Modified 120 360 0 Other-Visits and Calls
Total burden requested under this ICR: 17397 5876 0  
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