Focus Groups with Health Care Providers

CDC Cervical Cancer Study (CX3)

Documents and Forms

Document Name Document Type
Focus Groups with Health Care Providers Form
Provider Focus Group Moderator Guide C2 Provider Focus Group Moderator Guide 4 27 2012.docx Form
C2a Consent Form for Provider Focus Group Interviews.docx Focus Group Provider Consent IC Document

Information Collection (IC) Details

IC Title:	Focus Groups with Health Care Providers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Provider Focus Group Moderator Guide	C2 Provider Focus Group Moderator Guide 4 27 2012.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 252

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	75	52	23
Annual IC Time Burden (Hours)	75	63	12
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Focus Group Provider Consent	C2a Consent Form for Provider Focus Group Interviews.docx	05/17/2012

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