Information Collection

National Healthy Start Program Survey (NHSPS)

IC 195559 under ICR 201609-0915-003 · OMB 0915-0338.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0338 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form E National Healthy Start Program Survey (NHSPS)	Form and Instruction
E E. NHSPS Survey_revised.docx E. NHSPS Survey_revised.docx	Form and Instruction

IC Title:

National Healthy Start Program Survey (NHSPS)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	E	E. NHSPS Survey_revised.docx	E. NHSPS Survey_revised.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100	12	88
Annual IC Time Burden (Hours)	200	24	176
Annual IC Cost Burden (Dollars)	0	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.