Information Collection

Focus Groups to Support Development for PATH Study Wave 4 Items

IC 217824 under ICR 201303-0925-001 · OMB 0925-0675.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0675 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form B-2 Focus Groups to Support Development for PATH Study Wave 4 Items	Form and Instruction
A-1 Recruitment Screener PATH Focus Group Sub-study Attachment A-1. ENDS Recruitment Screener 062215.docx	Form and Instruction
A-2 Recruitment Screener PATH Focus Group Sub-study Attachment A-2. Social Media Recruitment Screener 061815.docx	Form and Instruction
B-1 Moderator Guide PATH Focus Group Sub-study Attachment B-1. Modifications Moderator Guide 062215.docx	Form and Instruction
B-2 Moderator Guide PATH Focus Group Sub-study Attachment B-2 Polyuse and Dual Use Focus Groups 070815.docx	Form and Instruction
B-3 Moderator Guide PATH Focus Group Sub-study Attachment B-3. Social Media Moderator Guide 062215.docx	Form and Instruction
B-4 Card Sort Images PATH Focus Group Sub-study Attachment B-4. Social Media Card Sort Images 060415.docx	Form and Instruction
PATH Study Focus Group Sub-study Memo 0925-0675 final rev 8-10-15.docx Gen IC Justification Memo	IC Document
PATH Focus Group Sub-study Attachment C. IRB Approval Letter.pdf IRB Letter	IC Document
PATH Focus Group Sub-study Attachment D-1. Adult ENDs Consent Form 061915.docx Adult ENDS Consent Form	IC Document
PATH Focus Group Sub-study Attachment D-2. Adult Social Media Consent Form 061915.docx Adult Consent Form	IC Document
PATH Focus Group Sub-study Attachment D-3. Parental Permission and Youth Assent Form 071715.docx Adult Consent and Youth Assent Form	IC Document

IC Title:

Focus Groups to Support Development for PATH Study Wave 4 Items

Agency IC Tracking Number:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	B-2	Moderator Guide	PATH Focus Group Sub-study Attachment B-2 Polyuse and Dual Use Focus Groups 070815.docx	Yes	Yes	Fillable Fileable
Form and Instruction	B-3	Moderator Guide	PATH Focus Group Sub-study Attachment B-3. Social Media Moderator Guide 062215.docx	Yes	Yes	Fillable Fileable
Form and Instruction	B-4	Card Sort Images	PATH Focus Group Sub-study Attachment B-4. Social Media Card Sort Images 060415.docx	Yes	Yes	Fillable Fileable
Form and Instruction	A-1	Recruitment Screener	PATH Focus Group Sub-study Attachment A-1. ENDS Recruitment Screener 062215.docx	Yes	Yes	Fillable Fileable
Form and Instruction	A-2	Recruitment Screener	PATH Focus Group Sub-study Attachment A-2. Social Media Recruitment Screener 061815.docx	Yes	Yes	Fillable Fileable
Form and Instruction	B-1	Moderator Guide	PATH Focus Group Sub-study Attachment B-1. Modifications Moderator Guide 062215.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,060

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
Annual Number of Responses for this IC	1,060	1,060
Annual IC Time Burden (Hours)	349	349
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Gen IC Justification Memo	PATH Study Focus Group Sub-study Memo 0925-0675 final rev 8-10-15.docx	08/10/2015
IRB Letter	PATH Focus Group Sub-study Attachment C. IRB Approval Letter.pdf	08/10/2015
Adult ENDS Consent Form	PATH Focus Group Sub-study Attachment D-1. Adult ENDs Consent Form 061915.docx	08/10/2015
Adult Consent Form	PATH Focus Group Sub-study Attachment D-2. Adult Social Media Consent Form 061915.docx	08/10/2015
Adult Consent and Youth Assent Form	PATH Focus Group Sub-study Attachment D-3. Parental Permission and Youth Assent Form 071715.docx	08/10/2015

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