Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
MCH Jurisdictional Survey Instrument for the Title V MCH Block Grant Program New 5955 1605 0 Form and Instruction 1 MCH Survey_Adult Parents_Puerto Rico_English Feb 2019.doc
Form and Instruction 2 MCH Survey_Adult Parents_US Virgin Islands_English Feb 2019.doc
Form and Instruction 3 MCH Survey_Adult Parents_Guam_English Feb 2019.doc
Form and Instruction 4 MCH Survey_Adult Parents_American Samoa_English Feb 2019.doc
Form and Instruction 5 MCH Survey_Adult Parents_Federated States of Micronesia_English Feb 2019.doc
Form and Instruction 6 MCH Survey_Adult Parents_Marshall Islands_English Feb 2019.doc
Form and Instruction 7 MCH Survey_Adult Parents_No Mariana Islands_English Feb 2019.doc
Form and Instruction 8 MCH Survey_Adult Parents_Palau_English Feb 2019.doc
Form and Instruction 1B MCH Survey_Adult Parents_PR_Spanish Feb 2019.doc
Form and Instruction 2B MCH Survey_Adult Parents_USVI_Spanish Feb 2019.doc
Form and Instruction 3B MCH Survey_Adult Parents_Guam_Tagalog Feb 2019.doc
Form and Instruction 3C MCH Survey_Adult Parents_Guam_Chuukese Feb 2019.doc
Form and Instruction 4B MCH Survey_Adult Parents_American Samoa_Samoan Feb 2019.doc
Form and Instruction 5B MCH Survey_Adult Parents_Fed States of Micronesia_Chuukese Feb 2019.doc
Form and Instruction 8B MCH Survey_Adult Parents_Palau_Palauan Feb 2019.doc
Form and Instruction 8C MCH Survey_Adult Parents_Palau_Tagalog Feb 2019.doc
Total burden requested under this ICR: 5955 1605 0  
To view an IC, click on IC Title