Information Collection

Caregiver Interview - 18-month follow-up

IC 225755 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/survey
Appx C_NSCAW III_Caregiver Interview_Revised_May2022_Clean.docx	Other-Interviews/survey
Appx C-1_NSCAW Caregiver Remote Interview_March 2023.docx	Other-Interview/survey
Appx C-1_NSCAW Caregiver Remote Interview_March 2023.docx	Other-Interview/survey

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
Other-Interviews/survey			Appx C_NSCAW III_Caregiver Interview_Revised_May2022_Clean.docx		Yes	Yes	Fillable Fileable
Other-Interview/survey			Appx C-1_NSCAW Caregiver Remote Interview_March 2023.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: 409

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	136	-924	1,060
Annual IC Time Burden (Hours)	102	-693	795
Annual IC Cost Burden (Dollars)	0	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.