Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Child and Youth Program Forms Modified 12055 1005 20252 Form DLA Form 1849 Child and Youth Program (CYP) Medication Consent and Administration Log
Form DLA Form 1849-1 DLA Child and Youth Program (CYP) Parental Consent for Field Trip
Form DLA Form 1849-2 DLA CYP Insect Repellent Use Consent
Form DLA Form 1849-3 DLA CYP Basic Care Item Consent to Apply
Form DLA Form 1849-4 DLA CYP Child Illness/Injury Readmission Record
Form DLA Form 1855 DLA Child and Youth Program Health/Developmental Screening
Form DLA Form 1855-1 DLA Child and Youth Program Health Assessment for Enrollment and Renewal
Form DLA Form 1855-1A DLA Child and Youth Program Respiratory Medical Action Plan
Form DLA Form 1855-1B DLA Child and Youth Program Special Diet Statement
Form DLA Form 1855-1C DLA Child and Youth Program Epilepsy/Seizure Medical Action Plan
Form DLA Form 1855-1D Part 1 DLA CYP Diabetes Daily Medical Action Plan
Form DLA Form 1855-1D Part II DLA CYP Diabetes Emergency Medical Action Plan
Form DLA Form 1855-1D Part III DLA CYP Diabetes Weekly Food and Carbohydrate Log
Form DLA Form 1855-1D Part IV DLA Child and Youth Program Blood Glucose and Ketone Monitoring Log
Form DLA Form 1855-1E DLA Child and Youth Program (CYP) Allergy Medical Action Plan
Form DLA Form 1855-1F DLA Child and Youth Program Consent to Perform Caregiving Health Practices and Authorization for Disclosure of Health Information
DLA CYP Health Screening/Assessment (DLA Forms 1855/1855-1) Removed 0 0 0 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 1849-1 Removed 0 0 0 Form DLA Form 1849-1 DLA Child and Youth Program (CYP) Parental Consent for Field Trip
DLA Form 1849-2 Removed 0 0 0 Form DLA Form 1849-2 DLA CYP Insect Repellent Use Consent
DLA Form 1849-3 Removed 0 0 0 Form DLA Form 1849-3 DLA CYP Basic Care Item Consent to Apply
DLA Form 1849-4 Removed 0 0 0 Form DLA Form 1849-4 DLA CYP Child Illness/Injury Readmission Record
DLA Form 1855-1A Removed 0 0 0 Form DLA Form 1855-1A DLA Child and Youth Program Respiratory Medical Action Plan
DLA Form 1855-1B Removed 0 0 0 Form DLA 1855-1B DLA Child and Youth Program Special Diet Statement
DLA Form 1855-1C Removed 0 0 0 Form DLA Form 1855-1C DLA Child and Youth Program Epilepsy/Seizure Medical Action Plan
DLA Form 1855-1D Removed 0 0 0 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 Removed 0 0 0 Form DLA Form 1855-1E DLA Child and Youth Program Allergy Medical Action Plan
DLA Form 1855-1F Removed 0 0 0 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 1005 20252  
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