Information Collection

Healthy Start Program Survey Instruments

IC 257575 under ICR 202309-0906-002 · OMB 0906-0076.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Program Survey Healthy Start Program Survey Instruments	Form and Instruction
Form 2 Network Survey Healthy Start Program Survey Instruments	Form and Instruction
Form 3 Participant Survey Healthy Start Program Survey Instruments	Form and Instruction
Form 5 Stakeholder Interview Healthy Start Program Survey Instruments	Form and Instruction
Form 4 Participant Survey Spanish Healthy Start Program Survey Instruments	Form and Instruction
Form 6 Results and Recommendations Healthy Start Program Survey Instruments	Form and Instruction
Attachment A2_HS Recruitment Email Program Survey.docx	Instruction
Attachment A2_HS Recruitment Email Program Survey.docx	Instruction
NSC A3_HS Recruitment Email Network Survey_8.28.23.docx	Instruction
NSC A3_HS Recruitment Email Network Survey_8.28.23.docx	Instruction
Attachment A4_HS Recruitment Email Participant Survey.docx	Instruction
Attachment A4_HS Recruitment Email Participant Survey.docx	Instruction
Attachment A5_HS Recruitment Email Participant Survey-Spanish.docx	Instruction
Attachment A5_HS Recruitment Email Participant Survey-Spanish.docx	Instruction
Attachment A6_HS Recruitment Email Stakeholder Interview Guide.docx	Instruction
Attachment A6_HS Recruitment Email Stakeholder Interview Guide.docx	Instruction
Attachment B7_HS Program Survey_FAQs.docx	Instruction
Attachment B7_HS Program Survey_FAQs.docx	Instruction
Attachment B8_HS Network Survey_FAQs.docx	Instruction
Attachment B8_HS Network Survey_FAQs.docx	Instruction
1 Program Survey Attachment B1_HS Program Survey (003).docx	Form and Instruction
1 Program Survey Attachment B1_HS Program Survey (003).docx	Form and Instruction
2 Network Survey NSC Version Attachment B2-HS Network Survey_082823.docx	Form and Instruction
2 Network Survey NSC Version Attachment B2-HS Network Survey_082823.docx	Form and Instruction
3 Participant Survey Attachment B3_HS Participant Survey.docx	Form and Instruction
3 Participant Survey Attachment B3_HS Participant Survey.docx	Form and Instruction
5 Stakeholder Interview Attachment B5_HS Stakeholder Interview Guide.docx	Form and Instruction
5 Stakeholder Interview Attachment B5_HS Stakeholder Interview Guide.docx	Form and Instruction
4 Participant Survey Spanish Attachment B4_HS Participant Survey-Spanish.docx	Form and Instruction
4 Participant Survey Spanish Attachment B4_HS Participant Survey-Spanish.docx	Form and Instruction
6 Results and Recommendations Attachment B6_Pilot Survey Results and Recommendations.docx	Form and Instruction
6 Results and Recommendations Attachment B6_Pilot Survey Results and Recommendations.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Healthy Start Program Survey Instruments

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Form and Instruction	1	Yes	Yes	Fillable Fileable
Form and Instruction	2	Yes	Yes	Fillable Fileable
Form and Instruction	3	Yes	Yes	Fillable Fileable
Form and Instruction	5	Yes	Yes	Fillable Fileable
Form and Instruction	4	Yes	Yes	Fillable Fileable
Form and Instruction	6	Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,601

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	Previously Approved
Annual Number of Responses for this IC	1,601	1,601
Annual IC Time Burden (Hours)	600	600
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.

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