Information Collection

Bundled Sub-studies #7 (PSA Decision Making Focus Groups) and #8 (PIO Customer Satisfaction Survey)

IC 195829 under ICR 201008-0925-004 · OMB 0925-0046.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0046 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Bundled Sub-studies #7 (PSA Decision Making Focus Groups) and #8 (PIO Customer Satisfaction Survey)	Form and Instruction
1 #7 Attach 7A, 7B, 7F Screener, FG Guide, Questionnaire #7 Attach 7A, 7B, 7F Screener, FG Guide, Questionnaire.docx	Form and Instruction
2 #8_Attach 8A_PIO Survey #8_Attach 8A_PIO Survey.docx	Form and Instruction
1 REVISED #7 #7_REV_Attach 7A 7B 7E Screener FG Guide Questionnaire.docx	Form and Instruction
Memo to OMB_Key to #7 and #8.doc Memo to OMB_Key to #7 and #8	IC Document
Combined GS Form_0925-0046-7 & -8.doc Combined GS Form_0925-0046-7 & -8	IC Document
#7 Justif Memo & Attach 7C & 7D_PSA_12-14-2010.docx #7 Justif Memo & Attach 7C & 7D_PSA_12-14-2010	IC Document
#8_Justif Memo_PIO CTEP.docx #8_Justif Memo_PIO CTEP	IC Document
#7_REV_Justif Memo Attach 7C 7D 7F_PSA_1-21-2011.docx REVISED #7 Justification Memo and attachments	IC Document

IC Title:

Bundled Sub-studies #7 (PSA Decision Making Focus Groups) and #8 (PIO Customer Satisfaction Survey)

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.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	#8_Attach 8A_PIO Survey	#8_Attach 8A_PIO Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1	REVISED #7	#7_REV_Attach 7A 7B 7E Screener FG Guide Questionnaire.docx	Yes	No	Fillable Fileable
Form and Instruction	1	#7 Attach 7A, 7B, 7F Screener, FG Guide, Questionnaire	#7 Attach 7A, 7B, 7F Screener, FG Guide, Questionnaire.docx	Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: SORN #09-25-0156, "Records of Participants in Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD"

FR Citation: 67 FR 60743

Number of Respondents: 410

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 60 %

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	410	0	0	0	0	0
Annual IC Time Burden (Hours)	119	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
Memo to OMB_Key to #7 and #8	Memo to OMB_Key to #7 and #8.doc	12/22/2010
Combined GS Form_0925-0046-7 & -8	Combined GS Form_0925-0046-7 & -8.doc	12/22/2010
#7 Justif Memo & Attach 7C & 7D_PSA_12-14-2010	#7 Justif Memo & Attach 7C & 7D_PSA_12-14-2010.docx	12/22/2010
#8_Justif Memo_PIO CTEP	#8_Justif Memo_PIO CTEP.docx	12/22/2010
REVISED #7 Justification Memo and attachments	#7_REV_Justif Memo Attach 7C 7D 7F_PSA_1-21-2011.docx	01/21/2011

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