Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.
Pre-testing for 2019 Health Center Patient Survey (HCPS)	New	88	77	0	Form and Instruction	1E
					Form and Instruction	1S
					Form and Instruction	2E
					Form and Instruction	2S
					Form and Instruction	2V
					Form and Instruction	2C
					Form and Instruction	2T
					Form and Instruction	3E
					Form and Instruction	3S
					Form and Instruction	3V
					Form and Instruction	3C
					Form and Instruction	3T
Title V Maternal and Child Health (MCH) Block Grant Jurisdictional MCH Survey Instrument	New	1757	226	0	Form	1
					Form	2
					Form	3
					Form	4
					Form	5
					Form	6
					Form	7
					Form	8
					Form	9
					Form	10
					Form	11
					Form	12
					Form	13
					Form	14
					Form	15
					Form	16
					Form	17
					Form	18
					Form	19
					Form	20
Total Burden Actually Used for Information Collections Under Currently Approved ICR:		1845	303	0
Total Burden Currently Requested for Information Collections Under Currently Approved ICR:		0	0	0
To view an IC, click on IC Title