Sub-study #13 - Focus Groups to Assess Implementation of the NCCCP-developed Template for Community Outreach (TCO)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0642 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Sub-study #13 - Focus Groups to Assess Implementation of the NCCCP-developed Template for Community Outreach (TCO) Form and Instruction
1 Moderator's Guide #13_Attach 2_TCO Moderator Guide .docx Form and Instruction
#13_Attach 1_TCO Email Invite.docx #13_Attach 1_TCO Email Invite IC Document
#13_Attach 3_TCO Survey Screenshots.pptx #13_Attach 3_TCO Survey Screenshots IC Document
#13_Attach 4_TCO_Template.pdf #13_Attach 4_TCO_Template IC Document
#13_Fast-Track Request_TCO_5-23-2012.docx #13_Fast-Track Request_TCO_5-23-2012 IC Document

Information Collection (IC) Details

IC Title:	Sub-study #13 - Focus Groups to Assess Implementation of the NCCCP-developed Template for Community Outreach (TCO)	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
Form and Instruction	1	Moderator's Guide	#13_Attach 2_TCO Moderator Guide .docx		No	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: SORN #09-25-0156, "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD"	FR Citation: 67 FR 60743

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

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	15	0	0	0	0	0
Annual IC Time Burden (Hours)	23	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
#13_Attach 1_TCO Email Invite	#13_Attach 1_TCO Email Invite.docx	05/24/2012
#13_Attach 3_TCO Survey Screenshots	#13_Attach 3_TCO Survey Screenshots.pptx	05/24/2012
#13_Attach 4_TCO_Template	#13_Attach 4_TCO_Template.pdf	05/24/2012
#13_Fast-Track Request_TCO_5-23-2012	#13_Fast-Track Request_TCO_5-23-2012.docx	06/01/2012

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