Information Collection

Caregivers - Focus Group Response Form

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

Documents and Forms

Documents and forms in this information collection
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

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.