Information Collection

Parent Interview

IC 227428 under ICR 201707-0930-003 · OMB 0930-0380.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Parent Questionnai Parent Interview	Form and Instruction
Parent Questionnai Parent Questionnaire NMHS OMB_PDF 03.pdf	Form and Instruction
NMHS OMB_PDF 10.pdf Parent Materials	IC Document

IC Title:

Parent Interview

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	Parent Questionnaire	Parent Questionnaire	NMHS OMB_PDF 03.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 210

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	210	210
Annual IC Time Burden (Hours)	105	105
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Parent Materials	NMHS OMB_PDF 10.pdf	07/10/2017

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