Information Collection

Consumer/Patient Focus Groups

IC 200339 under ICR 201112-0935-001 · OMB 0935-0191.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form #6 Consumer/Patient Focus Groups	Form and Instruction
Form #6 Consumer or Patient Focus Group Guide -- Aware with use Attachment H -- Consumer or Patient Focus Group Guide -- Aware With Use.doc	Form and Instruction
Form #7 Consumer or Patient Focus Group Guide -- Aware without u Attachment I -- Consumer or Patient Focus Group Guide -- Aware without Use.doc	Form and Instruction
Form #8 Consumer or Patient Focus Group Guide -- Unaware of CER Attachment J -- Consumer or Patient Focus Group Guide -- Unaware of CER.doc	Form and Instruction
Attachment L -- Consumer or Patient Focus Group Respondent Materials.doc Attachment L -- Consumer or Patient Focus Group Respondent Materials	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form #6	Consumer or Patient Focus Group Guide -- Aware with use	Attachment H -- Consumer or Patient Focus Group Guide -- Aware With Use.doc	Yes	Yes	Printable Only
Form and Instruction	Form #7	Consumer or Patient Focus Group Guide -- Aware without use	Attachment I -- Consumer or Patient Focus Group Guide -- Aware without Use.doc	Yes	Yes	Paper Only
Form and Instruction	Form #8	Consumer or Patient Focus Group Guide -- Unaware of CER	Attachment J -- Consumer or Patient Focus Group Guide -- Unaware of CER.doc	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 96

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	96	96
Annual IC Time Burden (Hours)	144	144
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment L -- Consumer or Patient Focus Group Respondent Materials	Attachment L -- Consumer or Patient Focus Group Respondent Materials.doc	11/30/2011

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