Sample Instrument: Parent/Caregiver Survey

Assessments to Inform Program Refinement for HIV, other STD, and Pregnancy Prevention among Middle and High-School Aged Youth

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1235 can be found here:

Documents and Forms

Document Name Document Type
Att 6-Sample Instrument-Parent-Caregiver Survey.docx Other-WORD

Information Collection (IC) Details

IC Title:	Sample Instrument: Parent/Caregiver Survey	Agency IC Tracking Number:	0920-1235

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-WORD			Att 6-Sample Instrument-Parent-Caregiver Survey.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15,000	15,000
Annual IC Time Burden (Hours)	6,250	6,250
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.