Information Collection

Health Care Consumer Focus Groups

IC 187251 under ICR 200902-0920-004 · OMB 0920-0801.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att D_Moderator Guide_HCC -FG_103008.doc	Other-WORD
Attachment D1 Consumer Informed Consent.doc Attachment D1 Consumer Informed Consent	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-WORD			Att D_Moderator Guide_HCC -FG_103008.doc		No	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 72

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	Previously Approved
Annual Number of Responses for this IC	72	72
Annual IC Time Burden (Hours)	144	144
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment D1 Consumer Informed Consent	Attachment D1 Consumer Informed Consent.doc	11/05/2008

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