Information Collection

Focus Groups about Alcohol Consumption during Pregnancy

IC 191180 under ICR 200807-0920-007 · OMB 0920-0798.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0798 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Focus Groups about Alcohol Consumption during Pregnancy	Form
Focus Group Guide Attachment 3.doc	Form
Participant Questionnaire Attachment 4.doc	Form
Screening Instrument Attachment 5.doc	Form
Consent Form Attachment 6.doc	Form
Attachment 1.pdf Authorizing Legislation	IC Document
Attachment 2.pdf Authorizing Legislation	IC Document
Attachment 7.doc Confirmation Letter	IC Document
Attachment 8.pdf IRB Approval	IC Document
Attachment 9.doc Recruitment Letter	IC Document
Project 3 OMB ap Section A 10-22-09.final.doc Supporting Statement A	IC Document

IC Title:

Focus Groups about Alcohol Consumption during Pregnancy

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Focus Group Guide	Attachment 3.doc	No	No	Paper Only
Form	none	Participant Questionnaire	Attachment 4.doc	No	No	Paper Only
Form	none	Screening Instrument	Attachment 5.doc	No	No	Paper Only
Form	none	Consent Form	Attachment 6.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 480

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 New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	480	0	0	0	0	0
Annual IC Time Burden (Hours)	317	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Authorizing Legislation	Attachment 1.pdf	10/05/2009
Authorizing Legislation	Attachment 2.pdf	10/05/2009
Confirmation Letter	Attachment 7.doc	10/05/2009
IRB Approval	Attachment 8.pdf	10/05/2009
Recruitment Letter	Attachment 9.doc	10/05/2009
Supporting Statement A	Project 3 OMB ap Section A 10-22-09.final.doc	10/26/2009

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