Information Collection

Children's and Aging Forums Data User Surveys

IC 221432 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⚠️ Notice: This information collection may be referencing outdated material.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's and Aging Forums Data User Surveys	Form and Instruction
Children’s Forum Data User Survey Questions Att A Children’s Forum Data User Survey Questions.docx	Form and Instruction
Aging Forum Data User Questions Att B Aging Forum Data User Survey Questions Revised.docx	Form and Instruction
Supporting Statement A_050516.doc Supporting Statement A	IC Document
Supporting Statement B 050516.docx Supporting Statement B	IC Document

IC Title:

Children's and Aging Forums Data User Surveys

Agency IC Tracking Number:

16AJB

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 and Instruction	NA	Childrenâs Forum Data User Survey Questions	Att A Childrenâs Forum Data User Survey Questions.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Aging Forum Data User Questions	Att B Aging Forum Data User Survey Questions Revised.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

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	2,000	2,000
Annual IC Time Burden (Hours)	267	267
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	Supporting Statement A_050516.doc	05/09/2016
Supporting Statement B	Supporting Statement B 050516.docx	05/09/2016

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