Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Home Visitor Survey Baseline Modified 170 213 0 Other-Survey
Supervisor Survey 12 Month Modified 33 41 0 Other-Survey
Community Service Provider Survey Modified 510 51 0 Other-Survey
Family Baseline Survey Modified 1700 1700 0 Other-Survey
Family Screening and Consent Modified 1889 189 0 Other-Screener
First Round Visits with State Administrators Modified 18 27 0 Other-Site Visits
Home Visitor Group Interview 12 Month Modified 57 86 0 Other-Interview
Home Visitor Individual Interview 12 Month Modified 57 86 0 Other-Interview
Home Visitor Logs Modified 10200 2040 0 Other-Logs
Home Visitor Survey 12 Month Modified 170 213 0 Other-Survey
Other Home Visiting Programs Survey Modified 142 14 0 Other-Survey
Program Manager Group Interview 12 Month Modified 29 44 0 Other-Interview
Program Manager Survey 12 Month Modified 29 58 0 Other-Survey
Program Manager Survey_Part 1 Baseline Modified 29 15 0 Other-Survey
Program Manager Survey_Part 2 Baseline Modified 29 29 0 Other-Survey
Program Manager Survey_Part 3 Baseline Modified 29 29 0 Other-Survey
Second Round Visits with State Administrators Modified 15 23 0 Other-Site Visits
State Administrator Interview 12 Month Modified 8 16 0 Other-Interview
Other-Interview
State Administrator Interview Baseline Modified 8 16 0 Other-Interview
Other-Interview
Supervisor Group Interview 12 Month Modified 33 50 0 Other-Interview
Supervisor Logs Modified 1980 396 0 Other-Logs
Supervisor Survey Baseline Modified 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: 17337 5786 0  
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