Healthy Start Survey

Evaluation of Core Components of the Federal Healthy Start Program

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.