Information Collection

Caregiver background survey

IC 230296 under ICR 201802-0970-013 · OMB 0970-0513.

Documents and Forms

Document Name Document Type
Attachment 3a. Background Survey_Caregiver_COPYRIGHT REMOVED_INCENTIVEREMOVED.pdf Other-Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Caregiver background 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
Other-Survey			Attachment 3a. Background Survey_Caregiver_COPYRIGHT REMOVED_INCENTIVEREMOVED.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	225	225
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.