Pre- and Post-Parent and Caretaker Survey

“Talk. They Hear You.” Campaign Evaluation: Case Studies

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0373 can be found here:

Documents and Forms

Document Name Document Type
Form Parent & Caregiver Pre- and Post-Parent and Caretaker Survey Form and Instruction
Parent & Caregiver Parent & Caregiver Pre-test Post-test Survey 1_Parent & Caregiver Pre-test Post-test Survey_January 20 2017.docx Form and Instruction
2_Parent & Caregiver Survey Invitation and Reminder_January 20 2017.docx Parent & Caregiver Survey Invitation and Reminder IC Document
8_Campaign Intervention Checklist_January 20 2017.docx Campaign Intervention Checklist IC Document

Information Collection (IC) Details

IC Title:	Pre- and Post-Parent and Caretaker Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Parent & Caregiver Pre-test Post-test Survey	Parent & Caregiver Pre-test Post-test Survey	1_Parent & Caregiver Pre-test Post-test Survey_January 20 2017.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 690	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,380	1,380
Annual IC Time Burden (Hours)	235	235
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Parent & Caregiver Survey Invitation and Reminder	2_Parent & Caregiver Survey Invitation and Reminder_January 20 2017.docx	01/30/2017
Campaign Intervention Checklist	8_Campaign Intervention Checklist_January 20 2017.docx	01/30/2017

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