Information Collection

Parents and other family members of Children (focus group)

IC 199536 under ICR 201110-0990-006 · OMB 0990-0384.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-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 %

table that charts list of burden
	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

table that charts IC Documents
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.