Information Collection

Provider Survey - Early childhood providers/professionals who use the Milestone Tracker app at least 3 times

IC 258177 under ICR 202605-0920-002 · OMB 0920-1397.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1397 Provider Survey Provider Survey - Early childhood providers/professionals who use the Milestone Tracker app at least 3 times	Form and Instruction
Form 0920-1397 Provider Survey - Spanish Provider Survey - Early childhood providers/professionals who use the Milestone Tracker app at least 3 times	Form and Instruction
0920-1397 Provider Survey G_Provider.docx	Form and Instruction
0920-1397 Provider Survey - Spanish MT Provider Survey Spanish FINAL .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	0920-1397			N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1397			N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 800

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	800	-99,200	100,000
Annual IC Time Burden (Hours)	67	-8,266	8,333
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.

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