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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.

Focus Groups to Support Development for PATH Study Wave 4 Items