Information Collection

Children and Aging Forums Feedback Survey

IC 217816 under ICR 201403-0920-018 · OMB 0920-0729.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0729 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Children and Aging Forums Feedback Survey	Form
Children and Aging Forums Feedback Survey Attachment A Children and Aging Forum Feedback Survey 072915.docx	Form
Children and Aging Forums SSA 080615 final.doc Supporting Statement A	IC Document
Children and Aging Forums SSB 080615 final.docx Supporting Statement B	IC Document

IC Title:

Children and Aging Forums Feedback Survey

Agency IC Tracking Number:

15BBJ

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	Children and Aging Forums Feedback Survey	Attachment A Children and Aging Forum Feedback Survey 072915.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,700

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
Annual Number of Responses for this IC	1,700	1,700
Annual IC Time Burden (Hours)	283	283
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	Children and Aging Forums SSA 080615 final.doc	08/10/2015
Supporting Statement B	Children and Aging Forums SSB 080615 final.docx	08/10/2015

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