Information Collection

Consumer Focus Groups

IC 189618 under ICR 200906-0583-001 · OMB 0583-0141.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Consumer Focus Groups	Form
Final moderator guide 9-16-09 (2).doc	Instruction
Focus Group Participant Worksheet.doc	Other-worksheet
Parents of Young Children < 5 yrs. old Focus Group Screening Questionnaire-Parents.doc	Form
General Population Focus Groups Screeening Questionnaire-General.doc	Form
Immunocompromised Focus Groups Screening Questionnaire-Immuno.doc	Form
Older Adults (60 +) Focus Groups Screening Questionnaire-Older.doc	Form
Young Adults ( 18-24 years old) Focus Groups Screening Questionnaire-YoungAd.doc	Form
Underserved Population Focus Groups Screening Questionnaire-Underserved.doc	Form
Consent Form Consent_Form_0208893 031.doc	Form
Parents of Young Children < 5 yrs. old Focus Group Screening Questionnaire-Parents_REV.doc	Form
Geberal Population Focus Groups Screening Questionnaire_general_REV.docx	Form
Immunocompromised Focus Groups Screening Questionnaire-Immuno_REV.doc	Form
Older Adults (60+) Focus Groups Screening Questionnaire-Older_REV.doc	Form
Young Adults Focus Groups Screening Questionnaire-YoungAd_REV.doc	Form
Underserved Population Focus Groups Screening Questionnaire-Underserved_REV.doc	Form
Consent Form Consent_Form_0208893 031_REV.doc	Form

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	Available Electronically?	Electronic Capability
Form	None	Immunocompromised	Focus Groups Screening Questionnaire-Immuno_REV.doc	No	Paper Only
Form	None	Older Adults (60+)	Focus Groups Screening Questionnaire-Older_REV.doc	No	Paper Only
Form	None	Underserved Population	Focus Groups Screening Questionnaire-Underserved_REV.doc	No	Paper Only
Form	None	Geberal Population	Focus Groups Screening Questionnaire_general_REV.docx	No	Paper Only
Form	None	Young Adults	Focus Groups Screening Questionnaire-YoungAd_REV.doc	No	Paper Only
Instruction			Final moderator guide 9-16-09 (2).doc	No	Paper Only
Form	None	Parents of Young Children < 5 yrs. old	Focus Group Screening Questionnaire-Parents.doc	No	Paper Only
Form	None	General Population	Focus Groups Screeening Questionnaire-General.doc	No	Paper Only
Form	None	Immunocompromised	Focus Groups Screening Questionnaire-Immuno.doc	No	Paper Only
Form	None	Older Adults (60 +)	Focus Groups Screening Questionnaire-Older.doc	No	Paper Only
Form	None	Young Adults ( 18-24 years old)	Focus Groups Screening Questionnaire-YoungAd.doc	No	Paper Only
Form	None	Underserved Population	Focus Groups Screening Questionnaire-Underserved.doc	No	Paper Only
Form	None	Consent Form	Consent_Form_0208893 031.doc	No	Paper Only
Other-worksheet			Focus Group Participant Worksheet.doc	No	Paper Only
Form	None	Parents of Young Children < 5 yrs. old	Focus Group Screening Questionnaire-Parents_REV.doc	No	Paper Only
Form	None	Consent Form	Consent_Form_0208893 031_REV.doc	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 132

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	220	220
Annual IC Time Burden (Hours)	198	198
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.