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Federal forms, ICRs, and supporting documents

Information Collection

Family/Caregiver Demographic Questionnaire

IC 267351 under ICR 202508-0906-004 · OMB unassigned.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Family/Caregiver Demographic Questionnaire
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 3_Revised Family Caregiver Demographic Questionaire Update 02.25.2025) Attachment B3 - Family-Caregiver Demographic Questionnaire_Redline Update 02252025.docx Yes Yes Fillable Fileable

Health Health Care Services

 

270 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 270 0 0 0 0 270
Annual IC Time Burden (Hours) 22 0 0 0 0 22
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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