Information Collection

Pre-Implementation Survey for Parents

IC 200247 under ICR 201111-0920-006 · OMB 0920-0911.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 A Pre-Implementation Survey for Parents--Spanish Pre-Implementation Survey for Parents	Form and Instruction
Form 3 A Pre-Implementation Survey for Parents--English Pre-Implementation Survey for Parents	Form and Instruction
Form 3c LTSAE ATT3C Pre-Implementation Survey for Parents (English) OMB Pre-Implementation Survey for Parents	Form and Instruction
Form 3d LTSAE ATT3D Pre-Implementation Survey for Parents (Spanish) OMB Pre-Implementation Survey for Parents	Form and Instruction
3 A Pre-Implementation Survey for Parents--English Att 3C Pre-implementation Survey for Parents 9 9 11.docx	Form and Instruction
4 A Pre-Implementation Survey for Parents--Spanish Att 3D Pre-implementation Survey for Parents (Spanish) 9 9 11.doc	Form and Instruction
3c LTSAE ATT3C Pre-Implementation Survey for Parents (Engli LTSAE att3C Pre-implementation Survey for Parents (English) OMB Rev.doc	Form and Instruction
3d LTSAE ATT3D Pre-Implementation Survey for Parents (Spani LTSAE att3D Pre-implementation Survey for Parents (Spanish) OMB Rev.doc	Form and Instruction

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 No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3	Yes	No	Paper Only
Form and Instruction	4	Yes	No	Paper Only
Form and Instruction	3c	Yes	No	Paper Only
Form and Instruction	3d	Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	167	167
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.

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