MUH Resident Focus Group Screening - ME, MN, FL

Adoption, Health Impact and Cost of Smoke-Free Multi-Unit Housing Policies

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1004 can be found here:

Documents and Forms

Document Name Document Type
MUH Resident Focus Group Screening - ME, MN, FL Form
Focus Group Screening Att 12A_Focus Group Screening Script.docx Form
Att 12A-1_Focus Group Recruitment Flyer.docx Recruitment Flyer IC Document
Att 12A-2_Other Focus Group Recruitment Materials.docx Recruitment Materials IC Document

Information Collection (IC) Details

IC Title:	MUH Resident Focus Group Screening - ME, MN, FL	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	Focus Group Screening	Att 12A_Focus Group Screening Script.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Recruitment Flyer	Att 12A-1_Focus Group Recruitment Flyer.docx	09/27/2012
Recruitment Materials	Att 12A-2_Other Focus Group Recruitment Materials.docx	09/27/2012

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