Pre-Implementation Survey for Parents

Evaluating Reach, Awareness, and Exposure of Enhanced Implementation of the Learn the Signs. Act Early. Campaign in Four Target Sites

Documents and Forms

Document Name Document Type
Form 4 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

Information Collection (IC) Details

IC Title:	Pre-Implementation Survey for Parents	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4	A Pre-Implementation Survey for Parents--Spanish	Att 3D Pre-implementation Survey for Parents (Spanish) 9 9 11.doc	Yes	No	Paper Only
Form and Instruction	3c	LTSAE ATT3C Pre-Implementation Survey for Parents (English) OMB	LTSAE att3C Pre-implementation Survey for Parents (English) OMB Rev.doc	Yes	No	Paper Only
Form and Instruction	3d	LTSAE ATT3D Pre-Implementation Survey for Parents (Spanish) OMB	LTSAE att3D Pre-implementation Survey for Parents (Spanish) OMB Rev.doc	Yes	No	Paper Only
Form and Instruction	3	A Pre-Implementation Survey for Parents--English	Att 3C Pre-implementation Survey for Parents 9 9 11.docx	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 %

	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

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.