Information Collection

Focus Groups with Community Leaders

IC 181263 under ICR 200707-0920-004 · OMB 0920-0756.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Focus Groups with Community Leaders	Form and Instruction
Demographics Form for Community Leaders Appendix K - Demographic data collection form_Comm leaders.doc	Form and Instruction
Focus Group Guide for Community Leaders Appendix I - Focus group data collection instrument_Comm leaders.doc	Form and Instruction
Appendices F, P- Focus group consent forms_Comm leaders.doc Focus Group Consent Forms for Community Leaders	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	Demographics Form for Community Leaders	Appendix K - Demographic data collection form_Comm leaders.doc		No	No	Paper Only
Form and Instruction	None	Focus Group Guide for Community Leaders	Appendix I - Focus group data collection instrument_Comm leaders.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)	64	64
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Focus Group Consent Forms for Community Leaders	Appendices F, P- Focus group consent forms_Comm leaders.doc	06/08/2007

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