Information Collection

Customer Focus Group Screener

IC 187117 under ICR 200811-0920-002 · OMB 0920-0803.

Documents and Forms

Document Name Document Type
Form no number Customer Focus Group Screener Form
no number Focus Group Screener Attachment D Focus Group Screener.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Customer Focus Group Screener	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	no number	Focus Group Screener	Attachment D Focus Group Screener.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 216	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	216	216
Annual IC Time Burden (Hours)	54	54
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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