Information Collection

Parent Screener--Main: Baseline & Follow-up Replenishments

IC 257638 under ICR 202410-0910-004 · OMB 0910-0915.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0915 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 2. Parent Guardian Online Screener ExPECTT 3_FU2_10-2024.docx	Other-ENGLISH Parent Guardian Online
Attachment 2. Parent Guardian Online Screener ExPECTT 3_FU2_10-2024.docx	Other-ENGLISH Parent Guardian Online
Attachment 2. Parent Guardian Online Screener ExPECTT 3_SPA_FU2_10-2024.docx	Other-SPANISH Parent Guardian Online
Attachment 2. Parent Guardian Online Screener ExPECTT 3_SPA_FU2_10-2024.docx	Other-SPANISH Parent Guardian Online

IC Title:

Parent Screener--Main: Baseline & Follow-up Replenishments

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-ENGLISH Parent Guardian Online Screener ExPECTT 3					Yes	Yes	Fillable Fileable Signable
Other-SPANISH Parent Guardian Online Screener ExPECTT 3					Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 345,000

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	Previously Approved
Annual Number of Responses for this IC	345,000	72,500	272,500
Annual IC Time Burden (Hours)	27,600	5,800	21,800
Annual IC Cost Burden (Dollars)	0	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].