Information Collection

Childcare Application Form

IC 202019 under ICR 201508-3045-001 · OMB 3045-0142.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0142 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Childcare Application Form Form and Instruction
1 Childcare Application w Privacy Statement Childcare Provider Application7.25.12.rtf www.nationalservice.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Childcare Application Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	Childcare Application w Privacy Statement	Childcare Provider Application7.25.12.rtf	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-2,250	2,250
Annual IC Time Burden (Hours)	-1,125	1,125
Annual IC Cost Burden (Dollars)	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.