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Att 6_Sample Instrument: Parent/Caregiver Survey
Assessments to Inform Program Refinement for HIV, other STD, and Pregnancy Prevention among Middle and High-School Aged Youth
OMB: 0920-1235
IC ID: 231029
OMB.report
HHS/CDC
OMB 0920-1235
ICR 201808-0920-005
IC 231029
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1235 can be found here:
2023-05-04 - No material or nonsubstantive change to a currently approved collection
2022-01-13 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0920-xxxx
Att 6_Sample Instrument: Parent/Caregiver Survey
Form
0920-xxxx Sample Instrument: Parent/Caregiver Survey
Att 6-Sample Instrument-Parent-Caregiver Survey.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Att 6_Sample Instrument: Parent/Caregiver Survey
Agency IC Tracking Number:
0920-18AF
IC Status:
Removed
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
0920-xxxx
Sample Instrument: Parent/Caregiver Survey
Att 6-Sample Instrument-Parent-Caregiver Survey.docx
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
7,500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
25 %
Requested
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
0
0
-15,000
0
0
15,000
Annual IC Time Burden (Hours)
0
0
-6,250
0
0
6,250
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.