Information Collection

Head Start Oral Health Initiative Evaluation

IC 45537 under ICR 200610-0970-002 · OMB 0970-0314.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0 Head Start Oral Health Initiative Evaluation	Form and Instruction
0 a OMB.communitypartner.revised0107.doc	Form and Instruction
0 a OMB.directorsitevisitinterview.revised0107.doc	Form
0 a OMB.directortelephoneinterivew.revised0107.doc	Form and Instruction
0 a OMB.keystaffinterview.revised0107.doc	Form and Instruction
0 a OMB.parentfocusgroup.revised0107.doc	Form and Instruction
0 a OMB.1directortelephoneinterivew.revised.doc	Form and Instruction
0 a OMB.2directorsitevisitinterview.revised.doc	Form
0 a OMB.3keystaffinterview.revised.doc	Form and Instruction
0 a OMB.4communitypartner.revised.doc	Form and Instruction
0 a OMB.5parentfocusgroup.revised.doc	Form and Instruction
6247 OMBresponses 010807_wjb.doc passback	IC Document
6247.OMBpresonses.Figure1.010807.doc OMBpresonses.Figure1.010807.doc	IC Document
6247.OMBrespones.EXhibit3.010807_wjb.doc OMBrespones.EXhibit3.010807_wjb.doc	IC Document
6247.OMBrespones.Exhibit3.a.010807_wjb.doc OMBrespones.Exhibit3.a.010807_wjb.doc	IC Document
6247.OMBrespones.Table2.010807.doc OMBrespones.Table2.010807.doc	IC Document
6247.OMBresponses.Exhibit1.010807.doc OMBresponses.Exhibit1.010807.doc	IC Document
6247.OMBresponses.Figure2.010807.doc OMBresponses.Figure2.010807.doc	IC Document
6247.OMBresponses.Table1.010807.doc OMBresponses.Table1.010807.doc	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	a	OMB.1directortelephoneinterivew.revised.doc	No	No	Paper Only
Form	a	OMB.2directorsitevisitinterview.revised.doc	No	No	Paper Only
Form and Instruction	a	OMB.3keystaffinterview.revised.doc	No	No	Paper Only
Form and Instruction	a	OMB.4communitypartner.revised.doc	No	No	Paper Only
Form and Instruction	a	OMB.5parentfocusgroup.revised.doc	No	No	Paper Only
Form and Instruction	a	OMB.parentfocusgroup.revised0107.doc	No		Paper Only
Form and Instruction	a	OMB.directortelephoneinterivew.revised0107.doc	No		Paper Only
Form	a	OMB.directorsitevisitinterview.revised0107.doc	No		Paper Only
Form and Instruction	a	OMB.communitypartner.revised0107.doc	No		Paper Only
Form and Instruction	a	OMB.keystaffinterview.revised0107.doc	No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 408

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 13 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	9,747	9,747
Annual IC Time Burden (Hours)	5,361	5,361
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
passback	6247 OMBresponses 010807_wjb.doc	01/10/2007
OMBpresonses.Figure1.010807.doc	6247.OMBpresonses.Figure1.010807.doc	01/10/2007
OMBrespones.EXhibit3.010807_wjb.doc	6247.OMBrespones.EXhibit3.010807_wjb.doc	01/10/2007
OMBrespones.Exhibit3.a.010807_wjb.doc	6247.OMBrespones.Exhibit3.a.010807_wjb.doc	01/10/2007
OMBrespones.Table2.010807.doc	6247.OMBrespones.Table2.010807.doc	01/10/2007
OMBresponses.Exhibit1.010807.doc	6247.OMBresponses.Exhibit1.010807.doc	01/10/2007
OMBresponses.Figure2.010807.doc	6247.OMBresponses.Figure2.010807.doc	01/10/2007
OMBresponses.Table1.010807.doc	6247.OMBresponses.Table1.010807.doc	01/10/2007

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