Information Collection

Parent or Caregiver Phone Screener and Invitation

IC 264290 under ICR 202409-0925-007 · OMB 0925-0781.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0781 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Parent or Caregiver Phone Screener and Invitation	Form
1 Screener Att A - Parent or Caregiver Phone Screener and Invitation - Revised Sept 2024.docx	Form
1 Screener Att A - Parent or Caregiver Phone Screener and Invitation - Revised Sept 2024.docx	Form
Att A - Parent Caregiver Phone Screener and Invitation Spanish - Revised Sept 2024.docx Screener Spanish	IC Document
Att A - Parent Caregiver Phone Screener and Invitation Spanish - Revised Sept 2024.docx Screener Spanish	IC Document

IC Title:

Parent or Caregiver Phone Screener and Invitation

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	1	Screener	Att A - Parent or Caregiver Phone Screener and Invitation - Revised Sept 2024.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 72

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	72	72
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Screener Spanish	Att A - Parent Caregiver Phone Screener and Invitation Spanish - Revised Sept 2024.docx	09/30/2024

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