Information Collection

Head Start Eligibility Verfication Form

IC 191567 under ICR 201211-0970-003 · OMB 0970-0374.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Head Start Eligibility Verfication Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	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 %

table that charts list of burden
	Approved	Previously Approved
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

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.