Information Collection

Parent or Caregiver "At-Home" Materials Review

IC 264300 under ICR 202501-0925-002 · OMB 0925-0781.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Parent or Caregiver "At-Home" Materials Review	Form and Instruction
Form 1 Materials Review Parent or Caregiver "At-Home" Materials Review	Form and Instruction
1 Materials Review Att M - Parent or Caregiver At Home Materials Review - Revised Dec 2024_Clean.docx	Form and Instruction
1 Materials Review Att M - Parent or Caregiver At Home Materials Review - Revised Dec 2024_Clean.docx	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	4	4
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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