Information Collection

Web Survey

IC 208013 under ICR 201308-0920-002 · OMB 0920-0991.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Web Survey	Form
Parent Survey Attachment 3a Amazing Me Parent Web Survey Screener and Survey Screenshots.pdf	Form
Attachment 3 Amazing Me Parent Web Survey FINAL Mar 15 2013.docx Parent Survey - Word	IC Document

IC Title:

Web Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Form	none	Parent Survey	Attachment 3a Amazing Me Parent Web Survey Screener and Survey Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 900

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Parent Survey - Word	Attachment 3 Amazing Me Parent Web Survey FINAL Mar 15 2013.docx	07/22/2013

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