Home-based provider QUESTIONNAIRE WITH SCREENER (unlisted home-based providers)

2019 National Survey of Early Care and Education COVID-19 Follow-up

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0391 can be found here:

Documents and Forms

Document Name Document Type
4a_2019 NSECE Home-based Provider Screener and Questionnaire (clean copy).docx Other-Questionnaire and Screener
4a_2019 NSECE Home-based Provider Screener and Questionnaire (clean)_051419.docx Other-SUMMER Screener & Questionnair
4a_2019 NSECE Home-based Provider Screener and Questionnaire (tracking copy).docx Revised Home-based Provider Screener and Questionnaire - Tracked Version - Nonsub Change Req Dec 2018 IC Document

Information Collection (IC) Details

IC Title:	Home-based provider QUESTIONNAIRE WITH SCREENER (unlisted home-based providers)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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-Questionnaire and Screener			4a_2019 NSECE Home-based Provider Screener and Questionnaire (clean copy).docx		Yes	Yes	Fillable Fileable
Other-SUMMER Screener & Questionnaire			4a_2019 NSECE Home-based Provider Screener and Questionnaire (clean)_051419.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: 2,100	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 %

	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-2,100	2,100
Annual IC Time Burden (Hours)	-693	693
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Revised Home-based Provider Screener and Questionnaire - Tracked Version - Nonsub Change Req Dec 2018	4a_2019 NSECE Home-based Provider Screener and Questionnaire (tracking copy).docx	12/06/2018

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