Information Collection

Focus Groups with Health Care Providers

IC 188622 under ICR 201205-0920-008 · OMB 0920-0814.

Documents and Forms

Documents and forms in this information collection
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

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.