View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Child and Youth Program Forms
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form DLA Form 1849 Child and Youth Program (CYP) Medication Consent and Administration Log DL1849.pdf Yes Yes Fillable Fileable Signable
Form DLA Form 1849-1 DLA Child and Youth Program (CYP) Parental Consent for Field Trip DL1849-1.pdf Yes Yes Fillable Fileable
Form DLA Form 1849-2 DLA CYP Insect Repellent Use Consent DL1849-2.pdf Yes Yes Fillable Fileable Signable
Form DLA Form 1849-3 DLA CYP Basic Care Item Consent to Apply DL1849-3.pdf Yes Yes Fillable Fileable Signable
Form DLA Form 1849-4 DLA CYP Child Illness/Injury Readmission Record DL1849-4.pdf Yes Yes Fillable Fileable Signable
Form DLA Form 1855 DLA Child and Youth Program Health/Developmental Screening DL1855.pdf Yes Yes Fillable Fileable Signable
Form DLA Form 1855-1 DLA Child and Youth Program Health Assessment for Enrollment and Renewal DL1855-1.pdf Yes Yes Fillable Fileable Signable
Form DLA Form 1855-1A DLA Child and Youth Program Respiratory Medical Action Plan DL1855-1A.pdf Yes Yes Fillable Fileable Signable
Form DLA Form 1855-1B DLA Child and Youth Program Special Diet Statement DL1855-1B.pdf Yes Yes Fillable Fileable Signable
Form DLA Form 1855-1C DLA Child and Youth Program Epilepsy/Seizure Medical Action Plan DL1855-1C.pdf Yes Yes Fillable Fileable Signable
Form DLA Form 1855-1D Part 1 DLA CYP Diabetes Daily Medical Action Plan DL1855-1D Part I.pdf Yes Yes Fillable Fileable Signable
Form DLA Form 1855-1D Part II DLA CYP Diabetes Emergency Medical Action Plan DL1855-1D Part 2.pdf Yes Yes Fillable Fileable Signable
Form DLA Form 1855-1D Part III DLA CYP Diabetes Weekly Food and Carbohydrate Log DL1855-1D Part III.pdf Yes Yes Fillable Fileable Signable
Form DLA Form 1855-1D Part IV DLA Child and Youth Program Blood Glucose and Ketone Monitoring Log DL1855-1D Part 4.pdf Yes Yes Fillable Fileable Signable
Form DLA Form 1855-1E DLA Child and Youth Program (CYP) Allergy Medical Action Plan DL1855-1E.pdf Yes Yes Fillable Fileable Signable
Form DLA Form 1855-1F DLA Child and Youth Program Consent to Perform Caregiving Health Practices and Authorization for Disclosure of Health Information DL1855-1F- OMB Review Final.pdf Yes Yes Fillable Fileable Signable

Defense and National Security Operational Defense

 

828 0
   
Individuals or Households
 
   95 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 12,055 0 10,399 0 0 1,656
Annual IC Time Burden (Hours) 1,005 0 873 0 0 132
Annual IC Cost Burden (Dollars) 20,252 0 17,337 0 0 2,915

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.