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OMB No: 09060017 Expiration Date: 07/31/2021THE MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAMAppendix H FORM 2PERFORMANCE AND SYSTEMS OUTCOME MEASURESPublic Burden Statement: An agency
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Provide detailed information about the mother and the infant, including personal details, medical history, and any complications during pregnancy or birth.
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