Information Collection

Household Roster--Main: Baseline & Follow-up 2 Replenishment

IC 257639 under ICR 202212-0910-013 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 1. Parent Guardian Mail Screener.docx	Other-ENGLISH Parent Guardian Mail S
Attachment 1. Parent Guardian Mail Screener.docx	Other-ENGLISH Parent Guardian Mail S
Attachment 1. Parent Guardian Mail Screener_rev_SPA_FINAL.docx	Other-SPANISH Parent Guardian Mail S
Attachment 1. Parent Guardian Mail Screener_rev_SPA_FINAL.docx	Other-SPANISH Parent Guardian Mail S

IC Title:

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
Other-ENGLISH Parent Guardian Mail Screener			Attachment 1. Parent Guardian Mail Screener.docx		No		Paper Only
Other-SPANISH Parent Guardian Mail Screener			Attachment 1. Parent Guardian Mail Screener_rev_SPA_FINAL.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	5,500	5,500
Annual IC Time Burden (Hours)	440	440
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.