Information Collection

Student Participant Focus Group

IC 201411 under ICR 201203-0920-002 · OMB 0920-0941.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0941 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ZZ Student Participant Focus Group	Form
ZZ Student participant focus group guide Atmt ZZ Student focus group guide_10-25-11.doc	Form
QQQ Student focus group participant assent form Atmt QQQ Student Focus Group Participant Assent Form_09-27-11.docx	Form

IC Title:

Student Participant Focus Group

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ZZ	Student participant focus group guide	Atmt ZZ Student focus group guide_10-25-11.doc		No		Paper Only
Form	QQQ	Student focus group participant assent form	Atmt QQQ Student Focus Group Participant Assent Form_09-27-11.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

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	80	80
Annual IC Time Burden (Hours)	120	120
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.