Information Collection

Focus Group Interview Guide

IC 203850 under ICR 201208-0920-006 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 2e Focus Group Guide.docx	Other-WORD
Att 3a Consent Form (In-Depth and Focus Group).docx Att 3a Consent Form (In-Depth and Focus Group)	IC Document

IC Title:

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
Other-WORD			Att 2e Focus Group Guide.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 3a Consent Form (In-Depth and Focus Group)	Att 3a Consent Form (In-Depth and Focus Group).docx	08/21/2012

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