Child-Care Dropout Questionnaire

Child-Care Dropout Questionnaire

OMB: 0960-0474

IC ID: 9367

Information Collection (IC) Details

View Information Collection (IC)

Child-Care Dropout Questionnaire
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.211(e)(4)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Internal MCS Screens SSA-4162 - MCS Screens.pdf Yes Yes Fillable Fileable Signable
Form SSA-4162 Child-Care Dropout Questionnaire SSA-4162 (Revised Version).pdf No   Paper Only
Other-Revised Privacy Act Statement SSA-4162 - Revised Privacy Act Statement.pdf No   Fillable Printable

Income Security General Retirement and Disability

 

2,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,000 0 0 0 0 2,000
Annual IC Time Burden (Hours) 167 0 0 0 0 167
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA-4162 Current Version SSA-4162 (Current Version).pdf 05/10/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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