Parents and other family members of Children (focus group)

CHIPRA_ Children Health Insurance

Documents and Forms

Document Name Document Type
0990-CHIP Part B_Attachment D1_Focus Group_Moderator Guide for Parents with Employer Insurance.pdf Other-focus group guide
0990-CHIP Part B_Attachment D2_Focus Group Moderator Guide for Parents of CHIP Enrollees.pdf Other-focus group guide
0990-CHIP Part A_Attachment D3_Focus Group Moderator Guide for Parents of CHIP Disenrollees.pdf Other-focus group guide
0990-CHIP Part A_Attachment D4_Focus Group Moderator Guide for Parents of Eligible but Uninsured.pdf Other-focus group guide

Information Collection (IC) Details

IC Title:	Parents and other family members of Children (focus group)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-focus group guide	0990-CHIP Part B_Attachment D1_Focus Group_Moderator Guide for Parents with Employer Insurance.pdf	Yes	Yes	Fillable Fileable
Other-focus group guide	0990-CHIP Part B_Attachment D2_Focus Group Moderator Guide for Parents of CHIP Enrollees.pdf	Yes	Yes	Fillable Fileable
Other-focus group guide	0990-CHIP Part A_Attachment D3_Focus Group Moderator Guide for Parents of CHIP Disenrollees.pdf	Yes	Yes	Fillable Fileable
Other-focus group guide	0990-CHIP Part A_Attachment D4_Focus Group Moderator Guide for Parents of Eligible but Uninsured.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 240	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	480	480
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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