Evaluation of Older Americans Act Title VI Programs-Tribal Caregivers Survey

Evaluation of Older Americans Act Title VI Programs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0059 can be found here:

Documents and Forms

Document Name Document Type
Form 7 Evaluation of Older Americans Act Title VI Programs-Tribal Caregivers Survey Form and Instruction
7 Title VI Tribal Caregiver Survey Title VI Tribal Caregiver Survey.docx Form and Instruction
7 Tribal Caregiver Survey Consent Form Title VI Tribal Caregiver Survey Consent-2-2.docx Form

Information Collection (IC) Details

IC Title:	Evaluation of Older Americans Act Title VI Programs-Tribal Caregivers 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	7	Title VI Tribal Caregiver Survey	Title VI Tribal Caregiver Survey.docx		No		Printable Only
Form	7	Tribal Caregiver Survey Consent Form	Title VI Tribal Caregiver Survey Consent-2-2.docx		No		Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 98	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	98	98
Annual IC Time Burden (Hours)	41	41
Annual IC Cost Burden (Dollars)	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.