eConsent Administer Focus Group Sessions Across Patient Population

Comprehensive Communication Campaign for HITECH ACT

Documents and Forms

Document Name Document Type
eConsentMaterial0990_0376.pptx Other-survey
20120411_Facilitator_Script_v4.pdf Other-Focus Group Script
0990_0376eConsenMini Supporting Statement.docx 0990_0376eConsenMini Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	eConsent Administer Focus Group Sessions Across Patient Population	Agency IC Tracking Number:

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
Other-Focus Group Script			20120411_Facilitator_Script_v4.pdf		No		Printable Only
Other-survey			eConsentMaterial0990_0376.pptx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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	50	0	0	0	0	0
Annual IC Time Burden (Hours)	75	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
0990_0376eConsenMini Supporting Statement	0990_0376eConsenMini Supporting Statement.docx	04/04/2012

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