Information Collection

#5. Primary Caregiver/home Visitor Child Rating

IC 186336 under ICR 201107-0970-005 · OMB 0970-0354.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0354 can be found here:

Documents and Forms

Document Name Document Type
#5. Primary Caregiver Home Visitor Child Rating.pdf Other-#5. PRIMARY CAREGIVER/HOME VIS

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	#5. PRIMARY CAREGIVER/HOME VISITOR CHILD RATING	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
Other-#5. PRIMARY CAREGIVER/HOME VISITOR CHILD RATING			#5. Primary Caregiver Home Visitor Child Rating.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 450	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,440	270	1,170
Annual IC Time Burden (Hours)	480	187	293
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.