Information Collection

Childcare Application Forms

IC 217805 under ICR 201508-3045-001 · OMB 3045-0142.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0142 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 Childcare Application Forms	Form and Instruction
1 Provider Application Provider Application (Child Care 4-8-2015).docx www.nationalservice.gov	Form and Instruction
2 Member Application Member Application (Child Care 4-8-2015).docx www.nationalservice.gov	Form and Instruction
3 Childcare Attendance Sheet AmeriCorp Childcare Attendance Sheet (Child Care 4-8-2015).doc www.nationalservice.gov	Form and Instruction
4 Statement of Work Activity Statement of Work Activity (Child Care 4-8-2015).docx www.nationalservice.gov	Form and Instruction
5 Member Update Form Member Update Form (Child Care 4-8-2015).docx www.nationalservice.gov	Form and Instruction

IC Title:

Childcare Application Forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	4	Statement of Work Activity	Statement of Work Activity (Child Care 4-8-2015).docx	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5	Member Update Form	Member Update Form (Child Care 4-8-2015).docx	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	1	Provider Application	Provider Application (Child Care 4-8-2015).docx	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	2	Member Application	Member Application (Child Care 4-8-2015).docx	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	3	Childcare Attendance Sheet	AmeriCorp Childcare Attendance Sheet (Child Care 4-8-2015).doc	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title: Corporation for National and Community Service

FR Citation: 67 FR 20

Number of Respondents: 1,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,400	1,400
Annual IC Time Burden (Hours)	1,575	1,575
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.