View Information Collection (IC)

View Information Collection (IC)

IC Title:	Parent Outcome Baseline Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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
Form and Instruction	none	Parent/Guardian Survey	Attachment H - Educator+Outcome+Survey.docx		Yes	No	Paper Only

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: 1,919	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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	1,919	0	0	0	0	1,919
Annual IC Time Burden (Hours)	1,919	0	0	0	0	1,919
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Atmt VV Parent Program Participant Consent Form	Atmt VV Parent Program Participant Consent Form.docx	02/27/2012

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