Information Collection

Onsite Health Intervention Form (OHIF)

IC 283114 under ICR 202609-0970-009 · OMB 0970-0509.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Onsite Health Intervention Form Onsite Health Intervention Form (OHIF)	Form
1 Onsite Health Intervention Form Onsite Health Intervention_Clean_9.30.26.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	1				Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: 09-80-0321 ORR Unaccompanied Children Bureau Administrative Program Records

FR Citation: 89 FR 100500

Number of Respondents: 150

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	48,240	48,240
Annual IC Time Burden (Hours)	4,342	4,342
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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