Information Collection

Caregiver Interview - Baseline

IC 225752 under ICR 202307-0970-005 · OMB 0970-0202.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appx C_NSCAW III_Caregiver Interview_Revised_May2022_Clean.docx	Other-Interviews
Appx C_NSCAW III_Caregiver Interview_Revised_May2022_Clean.docx	Other-Interviews
Appx C-1_NSCAW Caregiver Remote Interview_May 2022_Clean.docx Appx C-1_NSCAW Caregiver Remote Interview	IC Document
Appx C-1_NSCAW Caregiver Remote Interview_May 2022_Clean.docx Appx C-1_NSCAW Caregiver Remote Interview	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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
Other-Interviews			Appx C_NSCAW III_Caregiver Interview_Revised_May2022_Clean.docx		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: 1,117

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-372	372
Annual IC Time Burden (Hours)	-622	622
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appx C-1_NSCAW Caregiver Remote Interview	Appx C-1_NSCAW Caregiver Remote Interview_May 2022_Clean.docx	09/01/2022

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