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National Family Caregiver Support Program Outcome Evaluation - 12 month followup
National Family Caregiver Support Program (NFCSP) Outcome Evaluation
OMB: 0985-0052
IC ID: 218512
OMB.report
HHS/ACL
OMB 0985-0052
ICR 201705-0985-002
IC 218512
( )
Documents and Forms
Document Name
Document Type
Form 1
National Family Caregiver Support Program Outcome Evaluation - 12 month followup
Form and Instruction
1 National Family Caregiver Participant Survey 12 month su
Appendix_J_CaregiverComparisonGroupSurvey_Baseline.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
National Family Caregiver Support Program Outcome Evaluation - 12 month followup
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
1
National Family Caregiver Participant Survey 12 month survey
Appendix_J_CaregiverComparisonGroupSurvey_Baseline.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,250
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,250
0
0
0
0
1,250
Annual IC Time Burden (Hours)
838
0
0
0
0
838
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.