Form 1 RFCCMED Performance Data Form

							OMB Control Number 0970-0490
Reporting Date:							Expiration Date: 1/31/2020
Fiscal year _____ Refugee Family Child Care Program Performance Data Form	# of participants Enrolled	# of participants trained	# of people assisted to obtain business license	# of family child care businesses started	# of child care slots opened	Change in household income six months after business start	# of businesses sustained	Change in household income at end of program period for participants establishing businesses
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average 2 hours per response,
including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.