View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Healthy Start Program Survey Instruments	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment A2_HS Recruitment Email Program Survey.docx		Yes	Yes	Fillable Fileable
Instruction			Attachment A3_HS Recruitment Email Network Survey.docx		Yes	Yes	Fillable Fileable
Instruction			Attachment A4_HS Recruitment Email Participant Survey.docx		Yes	Yes	Fillable Fileable
Instruction			Attachment A5_HS Recruitment Email Participant Survey-Spanish.docx		Yes	Yes	Fillable Fileable
Instruction			Attachment A6_HS Recruitment Email Stakeholder Interview Guide.docx		Yes	Yes	Fillable Fileable
Form and Instruction	1	Program Survey	Attachment B1_HS Program Survey (003).docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	Network Survey	Attachment B2_HS Network Survey.docx		Yes	Yes	Fillable Fileable
Form and Instruction	3	Participant Survey	Attachment B3_HS Participant Survey.docx		Yes	Yes	Fillable Fileable
Form and Instruction	5	Stakeholder Interview	Attachment B5_HS Stakeholder Interview Guide.docx		Yes	Yes	Fillable Fileable
Form and Instruction	4	Participant Survey Spanish	Attachment B4_HS Participant Survey-Spanish.docx		Yes	Yes	Fillable Fileable
Form and Instruction	6	Results and Recommendations	Attachment B6_Pilot Survey Results and Recommendations.docx		Yes	Yes	Fillable Fileable
Instruction			Attachment B7_HS Program Survey_FAQs.docx		Yes	Yes	Fillable Fileable
Instruction			Attachment B8_HS Network Survey_FAQs.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,601	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	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	1,601	0	1,601	0	0	0
Annual IC Time Burden (Hours)	600	0	600	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

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.