Information Collection

Individual Interviews with Parents and Caregivers

IC 225439 under ICR 201912-0930-005 · OMB 0930-0373.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Teacher Script for Individual Interviews with Parents and Caregivers	Form and Instruction
Teacher Script for Teacher Script for Youth Survey Attachment_I_Teacher Script for Youth Survey-OMB-0930-0373 06302020.docx	Form and Instruction
Attachment_7_Youth Survey Parent Permission and Opt-Out Forms_OMB-0930-0373_12.4.19.docx Parent/Caregiver Interviews Consent	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Teacher Script for Youth Survey	Teacher Script for Youth Survey	Attachment_I_Teacher Script for Youth Survey-OMB-0930-0373 06302020.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Parent/Caregiver Interviews Consent	Attachment_7_Youth Survey Parent Permission and Opt-Out Forms_OMB-0930-0373_12.4.19.docx	12/04/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.