Information Collection

Caregiver Interview

IC 178551 under ICR 200702-0920-001 · OMB 0920-0741.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0741 can be found here:

Documents and Forms

Document Name Document Type
Appendix B 2 Caregiver Interview.doc Other-Primary Caregiver Interview
Appendix B 2 Caregiver Interview.doc Telephone Script IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Caregiver Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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-Primary Caregiver Interview			Appendix B 2 Caregiver Interview.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 3,456	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,456	3,456
Annual IC Time Burden (Hours)	3,456	3,456
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Telephone Script	Appendix B 2 Caregiver Interview.doc	06/05/2007

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