Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
1. MUSE Caregiver Enrollment Form 7.9.18_CLEAN Modified 434 35 0 Other-Enrollment Form
10. Program Implementation Survey 7.9.18 CLEAN Modified 11 3 0 Other-Survey
11. MUSE Home Visitor Interview Questions 7.9.18 Unchanged 14 28 0 Other-Interview Questions
12. MUSE Program Coordinator-Manager and Program Director Interview Questions 7.9.18 Unchanged 11 17 0 Other-Interview Questions
13. MUSE Local Evaluator Interview Questions 7.9.18 Unchanged 10 15 0 Other-Interview Questions
14. MUSE Caregiver Interview Questions 7.9.18 CLEAN Unchanged 17 17 0 Other-Interview Questions
15. MUSE Implementation Logs 7.9.18 CLEAN Modified 216 145 0 Other-Implementation Logs
16. MUSE Administrative Data Elements 7.26.18 CLEAN Modified 36 864 0 Other-Data Elements
2. MUSE Caregiver Baseline Survey 7.25.18 CLEAN Modified 188 47 0 Other-Caregiver Baseline Survey
3. MUSE Caregiver 6 12 Month Follow-Up Survey 7.25.18 CLEAN Modified 254 127 0 Other-Follow Up Survey
4. MUSE Rapid Reflect Caregiver 7.9.18 CLEAN Modified 3408 273 0 Other-Questionnaire
5. MUSE Rapid Reflect Home Visitor 7.25.18 CLEAN Modified 3102 620 0 Other-Questionnaire
6. MUSE Home Visitor Survey 7.25.18 CLEAN Modified 27 32 0 Other-Survey
7. MUSE Program Coordinator-Manager Survey 7.25.18 CLEAN Modified 7 7 0 Other-Survey
8. MUSE Program Director Survey 7.25.18 CLEAN Modified 7 5 0 Other-Survey
9. MUSE Local Program Evaluator Survey 7.9.18 CLEAN Modified 10 5 0 Other-Survey
Total burden requested under this ICR: 7752 2240 0  
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