Information Collection

Physician Focus Group

IC 187254 under ICR 200902-0920-004 · OMB 0920-0801.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment G Moderator Guide Physician FG.doc	Other-WORD
Attachment G1 Provider Recruitment Materials.doc Attachment G1 Provider Recruitment Materials	IC Document
Attachment G2 Physician Informed Consent.doc Attachment G2 Physician 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			Attachment G Moderator Guide Physician FG.doc		No	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24

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	24	24
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment G1 Provider Recruitment Materials	Attachment G1 Provider Recruitment Materials.doc	11/05/2008
Attachment G2 Physician Informed Consent	Attachment G2 Physician Informed Consent.doc	11/05/2008

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