Information Collection

Community Informants/Participants UCI

IC 187748 under ICR 200802-0925-003 · OMB 0925-0590.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0590 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Community Informants/Participants UCI	Form and Instruction
1 instrument 5. Appendix C - Anonymous Demographic Questionnaire.doc	Form and Instruction
2 guide 7. Appendix E - Focus Group Moderator Guide.doc	Form and Instruction
2. UCI Formative Research Cover Memo.rev.doc Revised UCI Formative Research Cover Memo	IC Document
6. Appendix D - Study Information Sheet for Focus Groups.rev.doc Revised Appendix D - Study Information Sheet for Focus Groups	IC Document
7. Appendix E - Focus Group Moderator Guide.rev.doc Revised Appendix E - Focus Group Moderator Guide	IC Document
8. Appendix F - Study Information Sheet for Key Informant Interviews.rev.doc Revised Appendix F - Study Information Sheet for Key Informant Interviews	IC Document
9. Appendix G - Recruitment Flyer for Focus Groups.rev.doc Revised Appendix G - Recruitment Flyer for Focus Groups	IC Document
1. Submission of Information Collection - UCI.doc 1	IC Document
2. UCI Formative Research Cover Memo.doc 2	IC Document
3. Appendix A - University of California-Irvine IRB Approval Memo.doc 3	IC Document
4. Appendix B - Summary of Methods and Segments.doc 4	IC Document
6. Appendix D - Study Information Sheet for Focus Groups.doc 6	IC Document
8. Appendix F - Study Information Sheet for Key Informant Interviews.doc 8	IC Document

IC Title:

Community Informants/Participants UCI

Agency IC Tracking Number:

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	1	instrument	5. Appendix C - Anonymous Demographic Questionnaire.doc		Yes	Yes	Paper Only
Form and Instruction	2	guide	7. Appendix E - Focus Group Moderator Guide.doc		Yes	Yes	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)	170	170
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
1	1. Submission of Information Collection - UCI.doc	01/05/2009
2	2. UCI Formative Research Cover Memo.doc	01/05/2009
3	3. Appendix A - University of California-Irvine IRB Approval Memo.doc	01/05/2009
4	4. Appendix B - Summary of Methods and Segments.doc	01/05/2009
6	6. Appendix D - Study Information Sheet for Focus Groups.doc	01/05/2009
8	8. Appendix F - Study Information Sheet for Key Informant Interviews.doc	01/05/2009
Revised UCI Formative Research Cover Memo	2. UCI Formative Research Cover Memo.rev.doc	03/31/2009
Revised Appendix D - Study Information Sheet for Focus Groups	6. Appendix D - Study Information Sheet for Focus Groups.rev.doc	03/31/2009
Revised Appendix E - Focus Group Moderator Guide	7. Appendix E - Focus Group Moderator Guide.rev.doc	03/31/2009
Revised Appendix F - Study Information Sheet for Key Informant Interviews	8. Appendix F - Study Information Sheet for Key Informant Interviews.rev.doc	03/31/2009
Revised Appendix G - Recruitment Flyer for Focus Groups	9. Appendix G - Recruitment Flyer for Focus Groups.rev.doc	03/31/2009

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