Information Collection

Instrument 2: Child roster form (from EHS staff)

IC 227597 under ICR 202009-0970-003 · OMB 0970-0354.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0354 can be found here:

Documents and Forms

Document Name Document Type
A2. Baby FACES 2020 Child Roster_for OMB_July 2020-clean.docx Other-Roster Form (2021)
Attachment 2. Baby FACES 2020 Child Roster Form from EHS staff_for OMB_J....docx Other-Roster Form (2020)

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Instrument 2: Child roster form (from EHS staff)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-Roster Form (2021)			A2. Baby FACES 2020 Child Roster_for OMB_July 2020-clean.docx		Yes	Yes	Fillable Fileable
Other-Roster Form (2020)			Attachment 2. Baby FACES 2020 Child Roster Form from EHS staff_for OMB_J....docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 350	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	175	49	126
Annual IC Time Burden (Hours)	59	17	42
Annual IC Cost Burden (Dollars)	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.