Information Collection

Caregivers - Focus Group Response Form

IC 181188 under ICR 200707-0920-003 · OMB 0920-0759.

Documents and Forms

Document Name Document Type
Caregivers - Focus Group Response Form Form and Instruction
Focus Group Response Form Attachment C5-Focus Group Response Form.doc Form and Instruction
Attachments C2-C4--Recruitment Documents.doc Focus Group Recruitment Brochure, Letter, and Flyer IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Caregivers - Focus Group Response Form	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	None	Focus Group Response Form	Attachment C5-Focus Group Response Form.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	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	100	100
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Focus Group Recruitment Brochure, Letter, and Flyer	Attachments C2-C4--Recruitment Documents.doc	06/17/2007

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