Information Collection

Consumer Focus Groups

IC 200140 under ICR 201208-0915-006 · OMB 0915-0347.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Focus Group-2 Consumer Focus Groups	Form
Focus Group-2 Focus Group: Participant Information Form (Pregnant Wome Part A Attachment D2 Participant Information Form Pregnant Women-FINAL.docx	Form
Focus Group-3 Focus Group: Participant Information Form (Postpartum Wo Part A Attachment D3 Participant Information Form Postpartum Women - FINAL.docx	Form
Focus Group-1 Focus Group Discussion Protocol Attachment D1 Consumer Focus Group Protocol May 2012.docx	Form

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Focus Group-2	Focus Group: Participant Information Form (Pregnant Women)	Part A Attachment D2 Participant Information Form Pregnant Women-FINAL.docx	No	No	Paper Only
Form	Focus Group-3	Focus Group: Participant Information Form (Postpartum Women)	Part A Attachment D3 Participant Information Form Postpartum Women - FINAL.docx	No	No	Paper Only
Form	Focus Group-1	Focus Group Discussion Protocol	Attachment D1 Consumer Focus Group Protocol May 2012.docx	No	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	Previously Approved
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.