View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Maternal, Infant, and Early Childhood Home Visiting (MIECHV) TA Satisfaction Survey	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	DOHVE 2	DOHVE 2 Satisfaction Survey 1.30.18_mj_clean.docx		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	150	0	0	0	0	150
Annual IC Time Burden (Hours)	25	0	0	0	0	25
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	DOHVE 2 Fast Track Generic - Submission Template_TA Satisfaction. 01-30-18. doc (2).doc	02/13/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.