Information Collection

Instrument 1: Classroom/ home visitor sampling form (from EHS staff)

IC 227596 under ICR 201907-0970-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment 1. Baby FACES 2020 Classroom_Home Visitor sampling form from ....docx Other-Sampling Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Instrument 1: Classroom/ home visitor sampling form (from EHS staff)	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-Sampling Form			Attachment 1. Baby FACES 2020 Classroom_Home Visitor sampling form from ....docx		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: 407	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	204	-90	294
Annual IC Time Burden (Hours)	35	-15	50
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.