Information Collection

SEED- Care Giver Interview

IC 178551 under ICR 201005-0920-003 · OMB 0920-0741.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix C 2 - Primary Caregiver Interview (3).doc	Other-word
Appendix_C.1_REV_Study Start PCGI_telescript 2007.doc	Other-WORD

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-word			Appendix C 2 - Primary Caregiver Interview (3).doc		Yes	Yes	Fillable Printable
Other-WORD			Appendix_C.1_REV_Study Start PCGI_telescript 2007.doc		Yes	Yes	Fillable Printable

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: 402

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	402	-3,054	3,456
Annual IC Time Burden (Hours)	603	-2,853	3,456
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.