Information Collection

USMC Child and Youth Programs Forms

IC 228240 under ICR 202302-0712-006 · OMB 0712-0006.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NAVMC 1750/5 USMC Child and Youth Programs Forms	Form and Instruction
NAVMC 1750/5 USMC Child and Youth Programs Registration Form NAVMC 1750_5.pdf	Form and Instruction
NAVMC 11720 USMC Family Care Programs Consent to Release Information NAVMC 11720.pdf	Form
NAVMC 1750/4 USMC Child and Youth Programs Health Assessment NAVMC 1750_4.pdf	Form
NAVMC 1750/7 USMC Child and Youth Programs Non-Medicated Topical Prod NAVMC 1750_7.pdf	Form and Instruction
NAVMC 1750/10 USMC Child and Youth Programs Medication Authorization a NAVMC 1750_10.pdf	Form and Instruction
NAVMC 1750/11 USMC Child and Youth Programs Controlled Medication Auth NAVMC 1750_11.pdf	Form and Instruction

IC Title:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NAVMC 1750/5	USMC Child and Youth Programs Registration Form	NAVMC 1750_5.pdf	Yes	Yes	Fillable Fileable Signable
Form	NAVMC 11720	USMC Family Care Programs Consent to Release Information	NAVMC 11720.pdf	Yes	Yes	Fillable Fileable Signable
Form	NAVMC 1750/4	USMC Child and Youth Programs Health Assessment	NAVMC 1750_4.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	NAVMC 1750/7	USMC Child and Youth Programs Non-Medicated Topical Products Authorization	NAVMC 1750_7.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	NAVMC 1750/10	USMC Child and Youth Programs Medication Authorization and Administration Record	NAVMC 1750_10.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	NAVMC 1750/11	USMC Child and Youth Programs Controlled Medication Authorization, Administration Record and Daily Log	NAVMC 1750_11.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 112,000

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	Previously Approved
Annual Number of Responses for this IC	247,500	135,500	112,000
Annual IC Time Burden (Hours)	115,917	-15,123	131,040
Annual IC Cost Burden (Dollars)	4,028,104	1,707,464	2,320,640

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.