Form 1 Center Locations and Contacts

OMB Control No: 0970-0427
Expiration date: X/XX/XXXX

Center Locations and Contacts

Edit Center Name and Information:

New Questions to be added not Shown Above:
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Does this center participate in the state or local quality rating and improvement
system (QRIS)?
o Yes/No/QRIS is not yet available (i.e., no state or local QRIS, or QRIS still in
development) [comment box]
Does this center have a state license to operate?
o Yes/No, this center is exempt/No, this center is not licensed for another
reason [comment box]

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average 0.25 hours per
response, including the time for reviewing instructions, gathering and maintaining the data needed, and
reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control
number.

License Definition: Licensing is a process administered by state and territory governments that sets a

baseline of requirements below, which it is illegal for f acilities to operate. States have regulations that
f acilities must comply with and policies to support the enforcement of those regulations. Some states may
call their regulatory processes “certification” or “registration.”

Edit Location:

Edit Programs and Their Class/Group Information:

Edit Contacts: