Caregivers - Focus Group Response Form

Assessment and Evaluation of the Role of Care Coordination (Case Management) in Improving Access and Care within the Spina Bifida Clinic System

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

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.