Information Collection

Children and Aging Forums Feedback Survey

IC 217816 under ICR 201403-0920-018 · OMB 0920-0729.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0729 can be found here:

Documents and Forms

Document Name Document Type
Children and Aging Forums Feedback Survey Form
Children and Aging Forums Feedback Survey Attachment A Children and Aging Forum Feedback Survey 072915.docx Form
Children and Aging Forums SSA 080615 final.doc Supporting Statement A IC Document
Children and Aging Forums SSB 080615 final.docx Supporting Statement B IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Children and Aging Forums Feedback Survey	Agency IC Tracking Number:	15BBJ

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	Children and Aging Forums Feedback Survey	Attachment A Children and Aging Forum Feedback Survey 072915.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,700	1,700
Annual IC Time Burden (Hours)	283	283
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	Children and Aging Forums SSA 080615 final.doc	08/10/2015
Supporting Statement B	Children and Aging Forums SSB 080615 final.docx	08/10/2015

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