Information Collection

Parents' Night Out Survey

IC 245916 under ICR 201910-0930-001 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Parents' Night Out Parents' Night Out Survey	Form and Instruction
Parents' Night Out Parents' Night Out Survey Parents_Night_Out_Survey(Attachment B).docx	Form and Instruction
PNO_Supplemental_Statement-Justification_Attachment B.docx PNO_Supplemental_Statement-Justification_Attachment B	IC Document

IC Title:

Parents' Night Out Survey

Agency IC Tracking Number:

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	Parents' Night Out Survey	Parents' Night Out Survey	Parents_Night_Out_Survey(Attachment B).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Parents' Night Out Survey

FR Citation: 75 FR 28264

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	500	500
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PNO_Supplemental_Statement-Justification_Attachment B	PNO_Supplemental_Statement-Justification_Attachment B.docx	02/22/2021

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