Information Collection

Healthy Start Survey

IC 195559 under ICR 201012-0915-001 · OMB 0915-0338.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0338 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 001_Healthy Start Healthy Start Survey	Form and Instruction
001_Healthy Start Healthy Start Survey_2010 Attachment C. HS Survey Survey Instrument_7.29.10.pdf	Form and Instruction

IC Title:

Healthy Start Survey

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 No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	001_Healthy Start Survey_2010	Healthy Start Survey_2010	Attachment C. HS Survey Survey Instrument_7.29.10.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 102

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	102	102
Annual IC Time Burden (Hours)	408	408
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.