Information Collection Request

National Family Caregiver Support Program (NFCSP) Outcome Evaluation

ICR 201510-0985-001 · OMB 0985-0052 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Comparison Group Care Recipient - 12 month followup Form and Instruction New Available
Form 1 Comparison Group Care Recipient Survey Form and Instruction New Available
Form 1 Caregiver Comparison Group Survey 12-month Form and Instruction New Available
Form 1 Caregiver Comparison Group Survey 6month Form and Instruction New Available
Form 1 Caregiver Comparison Group Survey Baseline Form and Instruction New Available
Form 1 Comparison Group Care Recipient Survey Form and Instruction New Available
Form 1 Caregiver Comparison Group Survey Baseline Form and Instruction New Available
Form 1 National Family Caregiver Participant Survey 12 month survey Form and Instruction New Available
Form 1 National Family Caregiver Support Program 6 month followup Form and Instruction New Available
Form 1 National Family Caregiver Support Program - Baseline Form and Instruction New Available
HHS Information Technology Security Program PIA Guide_v1-caregiver outcome evaluation-CLEAN 3-2-16.docx Supplementary Document Uploaded 2016-03-08 Available
ACL_CaregiverOutcomeEvaluation_OMB_PRA_SectionB_August_31_2015.docx Supporting Statement B Uploaded 2015-10-06 Available
CaregiverOutcomeEvaluation_PRA_SectionA_Passback_CLEAN 3-2-16 v2.docx Supporting Statement A Uploaded 2016-03-08 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
218730 Comparison group care recipients - 12 month followup Form and Instruction NewComparison Group Care Recipient - 12 month followup
218729 Comparison group of care recipients - Baseline Form and Instruction NewComparison Group Care Recipient Survey
218728 Comparison group non-NFCSP family caregivers - 12 month followup Form and Instruction NewCaregiver Comparison Group Survey 12-month
218727 Comparison group non-NFCSP family caregivers - 6 month followup Form and Instruction NewCaregiver Comparison Group Survey 6month
218516 Comparison Group non-NFCSP family caregivers - Baseline Form and Instruction NewCaregiver Comparison Group Survey Baseline
218515 National Family Caregiver Support Program (NFCSP) Outcome Evaluation Form and Instruction NewComparison Group Care Recipient Survey
218514 Care Recipients of NFCSP Clients Form and Instruction NewCaregiver Comparison Group Survey Baseline
218512 National Family Caregiver Support Program Outcome Evaluation - 12 month followup Form and Instruction NewNational Family Caregiver Participant Survey 12 month survey
218509 National Family Caregiver Support Program (NFCSP) Outcome Evaluation 6 month follow up Form and Instruction NewNational Family Caregiver Support Program 6 month followup
218477 National Family Caregiver Support Program Outcome Evaluation (Baseline) Form and Instruction NewNational Family Caregiver Support Program - Baseline

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2019 36 Months From Approved
12,500 0 0
5,514 0 0
0 0 0





Reginfo record details
10
table that charts list of burden
IC Title Form No. Form Name
Care Recipients of NFCSP Clients 1
Comparison Group non-NFCSP family caregivers - Baseline 1
Comparison group care recipients - 12 month followup 1
Comparison group non-NFCSP family caregivers - 12 month followup 1
Comparison group non-NFCSP family caregivers - 6 month followup 1
Comparison group of care recipients - Baseline 1
National Family Caregiver Support Program (NFCSP) Outcome Evaluation 1
National Family Caregiver Support Program (NFCSP) Outcome Evaluation 6 month follow up 1
National Family Caregiver Support Program Outcome Evaluation (Baseline) 1
National Family Caregiver Support Program Outcome Evaluation - 12 month followup 1

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 12,500 0 0 12,500 0 0
Annual Time Burden (Hours) 5,514 0 0 5,514 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No