Information Collection

Focus Group Moderator's Guide

IC 200325 under ICR 201305-0920-007 · OMB 0920-0915.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 4_FG Mod Gud.docx	Other-WORD
Demographic Information Sheet-1.docx Demographic Information Sheet-1	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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Att 4_FG Mod Gud.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

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	90	90
Annual IC Time Burden (Hours)	180	180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Demographic Information Sheet-1	Demographic Information Sheet-1.docx	01/05/2012

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