1 - Registration Questions FINAL_8.7.24

OCC Event Registration

This registration is administered by the project evaluators at the Office of Child Care (OCC). This data helps us plan for logistics and understand who is attending OCC sponsored webinars, meetings, events, and presentations. This data also offers insight into how we can better accommodate you for future events. The registration will take approximately three minutes to complete. Thank you for your time!

If you have questions about this survey, please contact OCC Communications at [email protected].

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to learn about your experiences at event. Public reporting burden for this collection of information is estimated to average 3 minutes per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. The agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0617 and the expiration date is 9/30/2026. If you have any comments on this collection of information, please contact the Office of Child Care Communications at [email protected].

First Name

Last Name

Email

Telephone Number

Your State or Territory (drop down list)

• Alabama 

• Alaska 

• American Samoa 

• Arizona 

• Arkansas 

• California 

• Colorado 

• Connecticut 

• Delaware 

• District of Columbia 

• Florida 

• Georgia 

• Guam 

• Hawaii 

• Idaho 

• Illinois 

• Indiana 

• Iowa 

• Kansas 

• Kentucky 

• Louisiana 

• Maine 

• Maryland 

• Massachusetts 

• Michigan 

• Minnesota 

• Mississippi 

• Missouri 

• Montana 

• Nebraska 

• Nevada 

• New Hampshire 

• New Jersey 

• New Mexico 

• New York 

• North Carolina 

• North Dakota 

• Northern Mariana Islands 

• Ohio 

• Oklahoma 

• Oregon 

• Pennsylvania 

• Puerto Rico 

• Rhode Island 

• South Carolina 

• South Dakota 

• Tennessee 

• Texas 

• U.S. Virgin Islands 

• Utah 

• Vermont 

• Virginia 

• Washington 

• West Virginia 

• Wisconsin 

• Wyoming 

• I do not reside in the United States 

• Not applicable 

Job Title

What organization/office are you from?

Are you representing a Stare or Territory Lead Agency?

☐ Yes

Please specify ______________

☐ No

Are you representing a Tribal Lead Agency?

☐ Yes

Please specify ______________

☐ No

Do you require any special accommodations?

☐ Yes

Please specify ______________

☐ No

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Modified	0000-00-00
File Created	0000-00-00