Head Start Eligibility Verfication Form

Head Start Eligibility Verification

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0374 can be found here:

Documents and Forms

Document Name Document Type
Form 0 Head Start Eligibility Verfication Form Form and Instruction
0 Head Start Eligibility Verification HS eligibiliy verification form 10 20 09.DOC Form and Instruction

Information Collection (IC) Details

IC Title:	Head Start Eligibility Verfication Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	0	Head Start Eligibility Verification	HS eligibiliy verification form 10 20 09.DOC		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,600	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	1,200,000	1,200,000
Annual IC Time Burden (Hours)	96,000	96,000
Annual IC Cost Burden (Dollars)	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.