Information Collection

Instrument 1: Classroom/ home visitor sampling form (from EHS staff)

IC 227596 under ICR 202203-0970-002 · OMB 0970-0354.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
A1. Baby FACES 2022 Classroom_HV sampling form_for OMB-clean.docx	Other-Sampling Form
A1. Baby FACES 2022 Classroom_HV sampling form_for OMB-clean.docx	Other-Sampling Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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
Other-Sampling Form			A1. Baby FACES 2022 Classroom_HV sampling form_for OMB-clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 407

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	204	204
Annual IC Time Burden (Hours)	35	35
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.