Information Collection

Screening for focus group sessions

IC 194105 under ICR 201011-0990-005 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 7 Screener for physician in-depth interviews, card sorting, web usability and focus groups.doc	Other-screener
Attachment 3 Screener for consumer focus groups, card sorting and web usability.doc	Other-Screening
Attachment 8 Screener for health staff focus groups.doc	Other-screener

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-screener	Attachment 7 Screener for physician in-depth interviews, card sorting, web usability and focus groups.doc	No	No	Paper Only
Other-Screening	Attachment 3 Screener for consumer focus groups, card sorting and web usability.doc	No	No	Paper Only
Other-screener	Attachment 8 Screener for health staff focus groups.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	133	133
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.