Information Collection

Valuing Reduced Asthma Episodes For Adults And Children -- Focus Groups

IC 179165 under ICR 200703-2010-001 · OMB 2010-0041.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Adult version Asthma survey.doc	Other-Focus Group Survey Instrument
Child version Asthma survey.doc	Other-Focus Group Survey Instrument
Focus Group Topics.doc	Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Focus Group Survey Instrument	Adult version Asthma survey.doc	Yes	Yes	Fillable Printable
Other-Focus Group Survey Instrument 2	Child version Asthma survey.doc	Yes	Yes	Fillable Printable
Instruction	Focus Group Topics.doc	No	No	Paper Only

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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