Individual Interviews with Parents and Caregivers

“Talk. They Hear You.” Campaign Evaluation: Case Studies

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0373 can be found here:

Documents and Forms

Document Name Document Type
Form Parent & Caregiver Individual Interviews with Parents and Caregivers Form and Instruction
Parent & Caregiver Parent & Caregiver Interview Guide 6_Parent & Caregiver Interview Guide_January 20 2017.docx Form and Instruction
5_Teacher Script for Youth Survey_January 20 2017.docx Teacher Script for Youth Survey IC Document
7_Consent Form_Parent caregiver Interviews Consent Form_January 20 2017.docx Consent Form_Parent caregiver Interviews Consent Form IC Document

Information Collection (IC) Details

IC Title:	Individual Interviews with Parents and Caregivers	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 and Instruction	Parent & Caregiver Interview Guide	Parent & Caregiver Interview Guide	6_Parent & Caregiver Interview Guide_January 20 2017.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Teacher Script for Youth Survey	5_Teacher Script for Youth Survey_January 20 2017.docx	01/30/2017
Consent Form_Parent caregiver Interviews Consent Form	7_Consent Form_Parent caregiver Interviews Consent Form_January 20 2017.docx	01/30/2017

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