Information Collection

Childcare Application Forms

IC 217805 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⚠️ Notice: This information collection may be referencing outdated material.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 4 Childcare Application Forms Form and Instruction
1 Provider Application Provider Application (Child Care 4-8-2015).docx www.nationalservice.gov Form and Instruction
2 Member Application Member Application (Child Care 4-8-2015).docx www.nationalservice.gov Form and Instruction
3 Childcare Attendance Sheet AmeriCorp Childcare Attendance Sheet (Child Care 4-8-2015).doc www.nationalservice.gov Form and Instruction
4 Statement of Work Activity Statement of Work Activity (Child Care 4-8-2015).docx www.nationalservice.gov Form and Instruction
5 Member Update Form Member Update Form (Child Care 4-8-2015).docx www.nationalservice.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Childcare Application Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	4	Statement of Work Activity	Statement of Work Activity (Child Care 4-8-2015).docx	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5	Member Update Form	Member Update Form (Child Care 4-8-2015).docx	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	1	Provider Application	Provider Application (Child Care 4-8-2015).docx	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	2	Member Application	Member Application (Child Care 4-8-2015).docx	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	3	Childcare Attendance Sheet	AmeriCorp Childcare Attendance Sheet (Child Care 4-8-2015).doc	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: Corporation for National and Community Service	FR Citation: 67 FR 20

Number of Respondents: 1,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,400	1,400
Annual IC Time Burden (Hours)	1,575	1,575
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.