Pre- and Post-Parent and Caretaker Survey

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

Documents and Forms

Document Name Document Type
Form Pre- and Post-Pare Pre- and Post-Parent and Caretaker Survey Form and Instruction
Pre- and Post-Pare Pre- and Post-Parent and Caretaker Survey Attachment_1_Parent & Caregiver Pre-test Post-test Survey-OMB-0930-0373_12.4.19.docx Form and Instruction
Attachment_2_Parent & Caregiver Survey Invitation and Reminder-OMB-0930-0373_12.4.19.docx Pre- and Post-Parent and Caretaker Survey Invite and Reminder IC Document
Attachment_6_Parent & Caregiver Interview Guide_OMB-0930-0373_12.4.19.docx Parent/Caregiver Interview Guide IC Document
Attachment_8_Campaign Intervention Checklist_OMB-0930-0373_12.4.19.docx Campaign Intervention Checklist IC Document

Information Collection (IC) Details

IC Title:	Pre- and Post-Parent and Caretaker Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Pre- and Post-Parent and Caretaker Survey	Pre- and Post-Parent and Caretaker Survey	Attachment_1_Parent & Caregiver Pre-test Post-test Survey-OMB-0930-0373_12.4.19.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 690	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,380	1,380
Annual IC Time Burden (Hours)	235	235
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Pre- and Post-Parent and Caretaker Survey Invite and Reminder	Attachment_2_Parent & Caregiver Survey Invitation and Reminder-OMB-0930-0373_12.4.19.docx	12/04/2019
Parent/Caregiver Interview Guide	Attachment_6_Parent & Caregiver Interview Guide_OMB-0930-0373_12.4.19.docx	12/04/2019
Campaign Intervention Checklist	Attachment_8_Campaign Intervention Checklist_OMB-0930-0373_12.4.19.docx	12/04/2019

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