Information Collection

Parent/Child Form

IC 211289 under ICR 202503-0915-001 · OMB 0915-0338.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4_Revised Parent/Child Form	Form and Instruction
Form 4_Revised 0915-0338_MCHB_HSMED_Parent Child Form_Redline_03052025 Parent/Child Form	Form and Instruction
4_Revised 0915-0338_MCHB_HSMED_Parent Child Form_Redline_03052025 Attachment 2 - ParentChild Form.docx	Form and Instruction
4_Revised 0915-0338_MCHB_HSMED_Parent Child Form_Redline_03052025 Attachment 2 - ParentChild Form.docx	Form and Instruction

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:

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	4_Revised				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 %

table that charts list of burden
	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

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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