Information Collection

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

IC 202647 under ICR 201108-0925-002 · OMB 0925-0642.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

View Information Collection (IC)

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:

table that charts list of 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

Federal Enterprise Architecture Business Reference Module

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 %

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	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

table that charts IC Documents
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.