Information Collection

Senior Corps Longitudinal Study: Caregiver Survey

IC 215851 under ICR 201503-3045-002 · OMB 3045-0173.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Caregiver Survey Senior Corps Longitudinal Study: Caregiver Survey	Form and Instruction
1 Caregiver Survey Baseline Questionnaire for Caregiver Study_Race_Eth Revised_6_10_15.docx	Form and Instruction

IC Title:

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 and Instruction	1	Caregiver Survey	Baseline Questionnaire for Caregiver Study_Race_Eth Revised_6_10_15.docx	www.nationalservice.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,666

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	1,666	1,666
Annual IC Time Burden (Hours)	694	694
Annual IC Cost Burden (Dollars)	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.