Information Collection

Patients at Primary Care Pactices (Patient Focus Groups)

IC 193000 under ICR 201208-0955-011 · OMB 0955-0011.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-PatientPerspective_App H2 Patient Recruitment Script Spanish.doc	Other-Script
0990-PatientPerspective_App K Focus Group Moderator's Guide.doc	Other-guide
0990-PatientPerspective_App H1 Patient Recruitment Script.doc	Other-recruitment
0990-PatientPerspective_App J2 Focus Group Postcard.doc 0990-PatientPerspective_App J2 Focus Group Postcard	IC Document
0990-PatientPerspective_App J1 Patient Focus Group Fact Sheet.doc 0990-PatientPerspective_App J1 Patient Focus Group Fact Sheet	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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Script	0990-PatientPerspective_App H2 Patient Recruitment Script Spanish.doc	No	No	Paper Only
Other-guide	0990-PatientPerspective_App K Focus Group Moderator's Guide.doc	No	No	Paper Only
Other-recruitment	0990-PatientPerspective_App H1 Patient Recruitment Script.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

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	20	20
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-PatientPerspective_App J2 Focus Group Postcard	0990-PatientPerspective_App J2 Focus Group Postcard.doc	05/04/2010
0990-PatientPerspective_App J1 Patient Focus Group Fact Sheet	0990-PatientPerspective_App J1 Patient Focus Group Fact Sheet.doc	05/04/2010

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