Information Collection

CMV Focus Group Screener

IC 202904 under ICR 201206-0920-007 · OMB 0920-0947.

Documents and Forms

Document Name Document Type
CMV Focus Group Screener Form
CMV Focus Group Screener Attachment 3A CMV Focus Group Screener.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CMV Focus Group Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	CMV Focus Group Screener	Attachment 3A CMV Focus Group Screener.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 144	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	144	144
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.