Information Collection

Participants selected

IC 189374 under ICR 201211-0955-001 · OMB 0955-0002.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A Focus Groups OMB 0955-0002 FINAL VERSION.doc	Other-evaluation
Attachment A Interviews OMB 0955-0002.doc	Other-guide

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-guide			Attachment A Interviews OMB 0955-0002.doc		No	No	Printable Only
Other-evaluation			Attachment A Focus Groups OMB 0955-0002 FINAL VERSION.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

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	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	52	10	42
Annual IC Time Burden (Hours)	78	15	63
Annual IC Cost Burden (Dollars)	0	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.