Information Collection

Risk and Benefit Perception Scale Development Focus Groups

IC 205791 under ICR 201103-0910-003 · OMB 0910-0497.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0497 can be found here:

Documents and Forms

Document Name Document Type
Appendix A_Screener.docx Other-Screener
Appendix B_Moderator Guide.docx Other-Moderator Guide
Appendix C_Consent Form.docx Other-Consent Form
OMB Justification memo.doc OMB Justification memo IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Risk and Benefit Perception Scale Development Focus Groups	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener	Appendix A_Screener.docx	Yes	Yes	Fillable Printable
Other-Moderator Guide	Appendix B_Moderator Guide.docx	Yes	Yes	Fillable Printable
Other-Consent Form	Appendix C_Consent Form.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 360	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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	360	0	0	0	0	0
Annual IC Time Burden (Hours)	189	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Justification memo	OMB Justification memo.doc	02/11/2013

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