Information Collection

Web Survey

IC 208013 under ICR 201308-0920-002 · OMB 0920-0991.

Documents and Forms

Document Name Document Type
Web Survey Form
Parent Survey Attachment 3a Amazing Me Parent Web Survey Screener and Survey Screenshots.pdf Form
Attachment 3 Amazing Me Parent Web Survey FINAL Mar 15 2013.docx Parent Survey - Word IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Web Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Parent Survey	Attachment 3a Amazing Me Parent Web Survey Screener and Survey Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 900	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	900	900
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Parent Survey - Word	Attachment 3 Amazing Me Parent Web Survey FINAL Mar 15 2013.docx	07/22/2013

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