Parent/Child Form

National Healthy Start Evaluation and Quality Assurance

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0338 can be found here:

Documents and Forms

Document Name Document Type
Form 3 Parent/Child Form Form and Instruction
3 FINAL New ParentChild Jan 2020.docx FINAL New ParentChild Jan 2020.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Parent/Child Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	3	FINAL New ParentChild Jan 2020.docx	FINAL New ParentChild Jan 2020.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	30,300	30,075	225
Annual IC Time Burden (Hours)	12,726	12,557	169
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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