Information Collection

HRSA Division of Transplantation Qualitative Assessment of Outreach Materials

IC 201008 under ICR 200904-0915-002 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Screener Interview HRSA Division of Transplantation Qualitative Assessment of Outreach Materials	Form
Form 2 Screener focusgroup HRSA Division of Transplantation Qualitative Assessment of Outreach Materials	Form
Form 3 Interview Guide HRSA Division of Transplantation Qualitative Assessment of Outreach Materials	Form
Form 4 Focus Group Guide HRSA Division of Transplantation Qualitative Assessment of Outreach Materials	Form
Attachment1_Informed Consent_interview.doc	Instruction
Attachment2_Informed Consent_focusgroup.doc	Instruction
1 Screener Interview Attachment3_Screener_interview.doc	Form
2 Screener focusgroup Attachment4_Screener_focusgroup.doc	Form
3 Interview Guide Attachment5_InterviewGuide.docx	Form
4 Focus Group Guide Attachment6_FocusGroupGuide.doc	Form
HRSA-DOT-SupportingStatementOrganDonation final.docx Supporting Statement	IC Document

IC Title:

HRSA Division of Transplantation Qualitative Assessment of Outreach Materials

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	No	Printable Only
Instruction		Yes	No	Printable Only
Form	1	Yes	No	Printable Only
Form	2	Yes	No	Printable Only
Form	3	Yes	No	Printable Only
Form	4	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 223

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	223	0	0	0	0	0
Annual IC Time Burden (Hours)	383	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
Supporting Statement		01/30/2012

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

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