Information Collection

Parent/Child Form

IC 211289 under ICR 202412-0915-001 · OMB 0915-0338.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0338 can be found here:

Documents and Forms

Document Name Document Type
Form 4 Parent/Child Form Form and Instruction
4 Parent Child Form B3 - Parent Child Form.docx Form and Instruction
4 Parent Child Form B3 - Parent Child Form.docx Form and Instruction
4_Revised Parent Child Form (Revised) Attachment 2 - ParentChild Form.docx Form and Instruction
4_Revised Parent Child Form (Revised) Attachment 2 - ParentChild Form.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Parent/Child Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4	Parent Child Form	B3 - Parent Child Form.docx		Yes	Yes	Fillable Fileable
Form and Instruction	4_Revised	Parent Child Form (Revised)	Attachment 2 - ParentChild Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Previously Approved
Annual Number of Responses for this IC	30,300	30,300
Annual IC Time Burden (Hours)	15,150	15,150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.