Information Collection

Discussion Groups

IC 194801 under ICR 201010-0920-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Discussion Groups	Form and Instruction
Discussion Group Moderator's Guide Attachment 3.1_Discussion Group Moderators Guide.doc	Form and Instruction
Attachment 3a_Consent Form for Discussion Groups.doc Consent form	IC Document
Attachment 3b_Discussion Group Reminder Email.doc Discussion Group Reminder Email	IC Document

IC Title:

Discussion 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Discussion Group Moderator's Guide	Attachment 3.1_Discussion Group Moderators Guide.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent form	Attachment 3a_Consent Form for Discussion Groups.doc	09/16/2010
Discussion Group Reminder Email	Attachment 3b_Discussion Group Reminder Email.doc	09/16/2010

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