Information Collection

Focus Groups and Individual Interviews with Women

IC 181262 under ICR 200707-0920-004 · OMB 0920-0756.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Focus Groups and Individual Interviews with Women	Form and Instruction
Demographics Form for Women Appendix J - Demographic data collection form_women.doc	Form and Instruction
Individual Interview Guide for Women Appendix H-Ind interview data collection instrument_Women.doc	Form and Instruction
Focus Group Guide for Women Appendix G - Focus group data collection instrument_Women.doc	Form and Instruction
Appendices D, N- Focus groups consent forms_Women.doc Focus Group Consent Forms for Women	IC Document
Appendices E, O -Individual interview consent forms_Women.doc Individual Interview Consent Forms for Women	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Demographics Form for Women	Appendix J - Demographic data collection form_women.doc	No	No	Paper Only
Form and Instruction	None	Individual Interview Guide for Women	Appendix H-Ind interview data collection instrument_Women.doc	No	No	Paper Only
Form and Instruction	None	Focus Group Guide for Women	Appendix G - Focus group data collection instrument_Women.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 32

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	32	32
Annual IC Time Burden (Hours)	128	128
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Focus Group Consent Forms for Women	Appendices D, N- Focus groups consent forms_Women.doc	06/08/2007
Individual Interview Consent Forms for Women	Appendices E, O -Individual interview consent forms_Women.doc	06/08/2007

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