View Information Collection (IC)

View Information Collection (IC)

[NCHS] CCQDER's Caregiver 0920-0222-23EN
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Caregiving Questions Attachment 1-Caregiving Questions.docx Yes No Fillable Fileable
Form and Instruction n/a Caregiving Screening Script Attachment 3- Caregiving Screening Script.docx No   Fillable Fileable
Form and Instruction n/a Respondent Data Collection Sheet Attachment 5- Respondent Data Collection Sheet.docx Yes No Fillable Fileable

Health Public Health Monitoring

 

45 0
   
Individuals or Households
 
   0 %

  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 45 0 45 0 0 0
Annual IC Time Burden (Hours) 35 0 35 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Advertisement Attachment 2- Caregiving Advertisement.docx 05/03/2023
Informed Consent Attachment 4a-4b - Caregiving Informed Consent.docx 05/03/2023
Thank You Letter Attachment 6- Thank You Letter.docx 05/03/2023
Data Retention Policy Attachment 7-Data Retention Policy.docx 05/03/2023
Non-Disclosure Affidavit Attachment 8- NCHS Non-Disclosure Affidavit.docx 05/03/2023
SSA SSA_Caregiving 4.27.23_final.docx 05/03/2023
SSB SSB_Caregiving 4.27.23.docx 05/03/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.