Information Collection

Screener for focus groups: early cessation

IC 190022 under ICR 200810-3084-010 · OMB 3084-0153.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CRA IDT Screener Draft.pdf	Other-
CRA IDT Screener Draft.pdf Screener for focus groups	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
Other-					No		Paper Only

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

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	400	400
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Screener for focus groups		07/22/2009

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

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