Information Collection

Parent Outcome Baseline Survey

IC 201399 under ICR 201203-0920-002 · OMB 0920-0941.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0941 can be found here:

Documents and Forms

Document Name Document Type
Form H Parent Outcome Baseline Survey Form and Instruction
H Attachment H: Parent Outcome Survey (Baseline) Atmt H - Parent Outcome Baseline Survey.docx Form and Instruction
Atmt VV Parent Program Participant Consent Form.docx Atmt VV Parent Program Participant Consent Form IC Document
Atmt SSS Screen shots parent survey_11-22-11 BT.doc Atmt SSS Screen shots parent survey_11-22-11 BT IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Parent Outcome Baseline Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	H	Attachment H: Parent Outcome Survey (Baseline)	Atmt H - Parent Outcome Baseline Survey.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,424	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
Annual Number of Responses for this IC	2,424	2,424
Annual IC Time Burden (Hours)	2,424	2,424
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Atmt VV Parent Program Participant Consent Form	Atmt VV Parent Program Participant Consent Form.docx	02/27/2012
Atmt SSS Screen shots parent survey_11-22-11 BT	Atmt SSS Screen shots parent survey_11-22-11 BT.doc	02/27/2012

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