Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
DLA CYP Health Screening/Assessment (DLA Forms 1855/1855-1) New 1656 132 2915 Form DLA Form 1855 DLA Child and Youth Program (CYP) Health/Developmental Screening
Form DLA Form 1855-1 DLA Child and Youth Program (CYP) Health Assessment for Enrollment and Renewal
DLA Form 1849 New 1656 132 2915 Form DLA 1849 Child and Youth Program (CYP) Medication Consent and Administration Log
DLA Form 1849-1 New 100 8 176 Form DLA Form 1849-1 DLA Child and Youth Program (CYP) Parental Consent for Field Trip
DLA Form 1849-2 New 828 66 1457 Form DLA Form 1849-2 DLA CYP Insect Repellent Use Consent
DLA Form 1849-3 New 6624 530 11658 Form DLA Form 1849-3 DLA CYP Basic Care Item Consent to Apply
DLA Form 1849-4 New 828 66 1457 Form DLA Form 1849-4 DLA CYP Child Illness/Injury Readmission Record
DLA Form 1855-1A New 15 1 26 Form DLA Form 1855-1A DLA Child and Youth Program Respiratory Medical Action Plan
DLA Form 1855-1B New 207 17 364 Form DLA 1855-1B DLA Child and Youth Program Special Diet Statement
DLA Form 1855-1C New 10 1 18 Form DLA Form 1855-1C DLA Child and Youth Program Epilepsy/Seizure Medical Action Plan
DLA Form 1855-1D New 6 0 11 Form DLA Form 1855-1D Part 1 DLA CYP Diabetes Daily Medical Action Plan
Form DLA Form 1855-1D Part 2 DLA CYP Diabetes Emergency Medical Action Plan
DLA Form 1855-1E New 50 4 88 Form DLA Form 1855-1E DLA Child and Youth Program Allergy Medical Action Plan
DLA Form 1855-1F New 75 6 132 Form DLA Form 1855-1F DLA Child and Youth Program Consent to Perform Caregiving Health Practices and Authorization for Disclosure of Health Information
Total burden requested under this ICR: 12055 963 21217  
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