Information Collection

Conduct Focus Groups to Test Messages and Materials

IC 198466 under ICR 201106-0990-003 · OMB 0990-0376.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A1 Screener for consumer focus groups non-English.doc	Other-study
Attachment A2 Screener for consumer focus groups caregivers.doc	Other-study
Attachment A3 Screener for consumer focus groups diabetes.doc	Other-study
Attachment B1 Screener for health professional focus groups.docx	Other-study
Attachment B2 Screener for health professionals nurses and PA groups.doc	Other-study
Attachment C Moderator Guide for consumer focus groups.docx	Other-study
Attachment D1 Moderator Guide for converted health professional group.doc	Other-study
Attachment D3 Moderator Guide for not planning health professional group.doc	Other-study
Attachment D2 Moderator Guide for planning health professional group.doc	Other-study
Attachment D4 Moderator Guide for health professionals nurses and PAs group.doc	Other-study
IC HITECH Focus Group Statement 07.07.11.docx IC HITECH Focus Group Statement 07	IC Document
IC HITECH Focus Group Statement 07.22.11.docx Updated IC HITECH Focus Group Supporing Statement	IC Document
FINAL_Focus Group Materials_COMBINED.pdf Visuals for Focus Groups	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

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-study	Attachment A1 Screener for consumer focus groups non-English.doc	No	No	Fillable Printable
Other-study	Attachment A2 Screener for consumer focus groups caregivers.doc	No	No	Fillable Printable
Other-study	Attachment A3 Screener for consumer focus groups diabetes.doc	No	No	Fillable Printable
Other-study	Attachment B1 Screener for health professional focus groups.docx	No	No	Fillable Printable
Other-study	Attachment B2 Screener for health professionals nurses and PA groups.doc	No	No	Fillable Printable
Other-study	Attachment C Moderator Guide for consumer focus groups.docx	No	No	Fillable Printable
Other-study	Attachment D1 Moderator Guide for converted health professional group.doc	No	No	Fillable Printable
Other-study	Attachment D3 Moderator Guide for not planning health professional group.doc	No	No	Fillable Printable
Other-study	Attachment D2 Moderator Guide for planning health professional group.doc	No	No	Fillable Printable
Other-study	Attachment D4 Moderator Guide for health professionals nurses and PAs group.doc	No	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,352

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

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	4,352	0	0	0	0	0
Annual IC Time Burden (Hours)	1,088	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
IC HITECH Focus Group Statement 07	IC HITECH Focus Group Statement 07.07.11.docx	07/09/2011
Updated IC HITECH Focus Group Supporing Statement	IC HITECH Focus Group Statement 07.22.11.docx	07/25/2011
Visuals for Focus Groups	FINAL_Focus Group Materials_COMBINED.pdf	07/25/2011

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