ED Professionals Focus Groups

Assessment of the Emergency Severity Index (ESI)

Documents and Forms

Document Name Document Type
Form Form #2 ED Professionals Focus Groups Form and Instruction
Form #2 Focus Group Protocal Attachment C - Focus Group Protocol.doc Form and Instruction
Attachment O- Flyer for Focus Group Recruitment.doc Attachment O- Flyer for Focus Group Recruitment IC Document
Attachment H - Written Informed Consent for Focus Groups.doc Attachment H - Written Informed Consent for Focus Groups IC Document

Information Collection (IC) Details

IC Title:	ED Professionals Focus Groups	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	Form #2	Focus Group Protocal	Attachment C - Focus Group Protocol.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 32	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	32	32
Annual IC Time Burden (Hours)	48	48
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment O- Flyer for Focus Group Recruitment	Attachment O- Flyer for Focus Group Recruitment.doc	04/04/2008
Attachment H - Written Informed Consent for Focus Groups	Attachment H - Written Informed Consent for Focus Groups.doc	04/04/2008

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