Information Collection

Screener for Focus Groups

IC 194004 under ICR 201007-0920-010 · OMB 0920-0869.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0869 can be found here:

2010-11-29 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3a 0920-09CJ_att3a_Screener for One-on-One Interviews.10062010- Screener for Focus Groups	Form and Instruction
Form 3a Screening Tool Screener for Focus Groups	Form and Instruction
Form 3c Screener for One-on-One Surveys Screener for Focus Groups	Form and Instruction
Form 3d Survey Instruments Screener for Focus Groups	Form
Form 3e Screener for Focus Groups Screener for Focus Groups	Form and Instruction
Form 3c 0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.10062010 Screener for Focus Groups	Form and Instruction
Form 3e 0920-09CJ_att3e_Phase 3 Screener for Focus Groups.10062010. Screener for Focus Groups	Form and Instruction
0920-09CJ_att3b_One-on-One Interview Guide OADS.06162010.docx	Other-Interview Guide
0920-09CJ_att3b_One-on-One Interview Guide OADS 10062010.docx	Other-Interview Guide att3b 100610
3a Screening Tool 0920-09CJ_att3a_Screener for One-on-One Interviews.OADS.docx	Form and Instruction
3c Screener for One-on-One Surveys 0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.OADS.docx	Form and Instruction
3d Survey Instruments 0920-09CJ_att3d_Phase 2 One-on-One Surveys.OADS.docx	Form
3e Screener for Focus Groups 0920-09CJ_att3e_Phase 3 Screener for Focus Groups.OADS.docx	Form and Instruction
3c 0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys. 0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.10062010.docx	Form and Instruction
3e 0920-09CJ_att3e_Phase 3 Screener for Focus Groups.100620 0920-09CJ_att3e_Phase 3 Screener for Focus Groups.10062010.docx	Form and Instruction
3a 0920-09CJ_att3a_Screener for One-on-One Interviews.10062 0920-09CJ_att3a_Screener for One-on-One Interviews.10062010-1.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Screener for Focus Groups

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?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3a	0920-09CJ_att3a_Screener for One-on-One Interviews.10062010-	0920-09CJ_att3a_Screener for One-on-One Interviews.10062010-1.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3e	0920-09CJ_att3e_Phase 3 Screener for Focus Groups.10062010.	0920-09CJ_att3e_Phase 3 Screener for Focus Groups.10062010.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3a	Screening Tool	0920-09CJ_att3a_Screener for One-on-One Interviews.OADS.docx	Yes	Yes	Fillable Fileable
Other-Interview Guide			0920-09CJ_att3b_One-on-One Interview Guide OADS.06162010.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3c	Screener for One-on-One Surveys	0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.OADS.docx	Yes	Yes	Fillable Fileable
Form	3d	Survey Instruments	0920-09CJ_att3d_Phase 2 One-on-One Surveys.OADS.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3e	Screener for Focus Groups	0920-09CJ_att3e_Phase 3 Screener for Focus Groups.OADS.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3c	0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.10062010	0920-09CJ_att3c_Phase 2 Screener for One-on-One Surveys.10062010.docx	Yes	Yes	Fillable Fileable
Other-Interview Guide att3b 100610			0920-09CJ_att3b_One-on-One Interview Guide OADS 10062010.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	7	7
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.