Information Collection

Screener Interviews for Selected Women to Participate in Focus Group Study

IC 195474 under ICR 201011-0920-009 · OMB 0920-0878.

Documents and Forms

Document Name Document Type
Form Attachment 3 Screener Interviews for Selected Women to Participate in Focus Group Study Form
Attachment 3 Screener Interviews for Selected Women to Participate in Attachment_3_Screener_for_Focus_Group1_OMB_Final.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Screener Interviews for Selected Women to Participate in Focus Group Study	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Attachment 3	Screener Interviews for Selected Women to Participate in Focus Group Study	Attachment_3_Screener_for_Focus_Group1_OMB_Final.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 252	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	252	252
Annual IC Time Burden (Hours)	21	21
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.