Information Collection

mHealth focus groups

IC 200676 under ICR 201106-0990-003 · OMB 0990-0376.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0376_mHealth_Questionnaire_12_9_FINAL.docx	Other-survey
0990-0376_mHealth_Screener_12_9_FINAL.doc	Other-survey
0990-0376_mHealthModeratorsGuide12_9.docx	Other-guide
0990-0376_mHealth Attachment A_12_9_FINAL.docx 0990-0376_mHealth Attachment A_12_9_FINAL	IC Document
0990-0376_Generic_Clearance_mHealth12.21.docx 0990-0376_Generic_Clearance_mHealth12	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-survey	0990-0376_mHealth_Screener_12_9_FINAL.doc	Yes	Yes	Fillable Printable
Other-survey	0990-0376_mHealth_Questionnaire_12_9_FINAL.docx	Yes	Yes	Fillable Printable
Other-guide	0990-0376_mHealthModeratorsGuide12_9.docx	No	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 96

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	96	0	0	0	0	0
Annual IC Time Burden (Hours)	60	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
0990-0376_mHealth Attachment A_12_9_FINAL	0990-0376_mHealth Attachment A_12_9_FINAL.docx	12/21/2011
0990-0376_Generic_Clearance_mHealth12	0990-0376_Generic_Clearance_mHealth12.21.docx	12/21/2011

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