Information Collection

Parent Outcome Baseline Survey

IC 201399 under ICR 201408-0920-001 · OMB 0920-0941.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0941 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Parent Outcome Baseline Survey	Form and Instruction
Parent/Guardian Survey Attachment H - Educator+Outcome+Survey.docx	Form and Instruction
Atmt VV Parent Program Participant Consent Form.docx Atmt VV Parent Program Participant Consent Form	IC Document

IC Title:

Parent Outcome Baseline Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	none	Parent/Guardian Survey	Attachment H - Educator+Outcome+Survey.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,919

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	1,919	1,919
Annual IC Time Burden (Hours)	1,919	1,919
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Atmt VV Parent Program Participant Consent Form	Atmt VV Parent Program Participant Consent Form.docx	02/27/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.