Information Collection

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

IC 227564 under ICR 201707-0985-002 · OMB 0985-0059.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	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

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.