Information Collection

SEED- Care Giver Interview

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SEED- Care Giver Interview	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-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 %

	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

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.