Caregiver Survey

Targeted Surveillance and Biometric Studies for Enhanced Evaluation of CTGs

Documents and Forms

Document Name Document Type
Caregiver Survey Form
Caregiver Survey Att 9A_CaregiverSurvey.docx Form
Caregiver Survey - Spanish Att 9A-S_CaregiverSurvey_SP.docx Form
Att 9C_Youth_CaregiverSurvey_ItemSources_2013_0618.pdf Att 9C_Youth_CaregiverSurvey_ItemSources_2013_0618 IC Document

Information Collection (IC) Details

IC Title:	Caregiver Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Caregiver Survey	Att 9A_CaregiverSurvey.docx		Yes	Yes	Fillable Fileable
Form	none	Caregiver Survey - Spanish	Att 9A-S_CaregiverSurvey_SP.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 960	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	960	960
Annual IC Time Burden (Hours)	320	320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 9C_Youth_CaregiverSurvey_ItemSources_2013_0618	Att 9C_Youth_CaregiverSurvey_ItemSources_2013_0618.pdf	08/06/2013

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