Information Collection

"Talk. They Hear You" - Parents

IC 222612 under ICR 201306-0930-003 · OMB 0930-0196.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0196 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Focus Group Protoc "Talk. They Hear You" - Parents	Form and Instruction
Focus Group Protoc Focus Group Protocol Attachment A 2016_7_19_OMB Package_UAD_Community Conversations_Focus Group Protocol.docx	Form and Instruction
Screener Screener Attachment B 2016_7_20_UAD Community dialogue_ PSA Screener.docx	Form and Instruction
Consent Form Consent Form Attachment C 2016_7_18_UAD_Community dialogue_Consent Form.docx	Form and Instruction
Facilitator Guide Facilitator Guide Attachment D 2016_7_19_UAD Community dialogue_Focus Group Guide.docx	Form and Instruction
TransLet-8doc.doc Transmittal Letter	IC Document
2016_07_25_OMB 2016_Package_UAD_Community conversations_Focus Group.docx Justification	IC Document

IC Title:

"Talk. They Hear You" - Parents

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	Focus Group Protocol	Focus Group Protocol	Attachment A 2016_7_19_OMB Package_UAD_Community Conversations_Focus Group Protocol.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Screener	Screener	Attachment B 2016_7_20_UAD Community dialogue_ PSA Screener.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Consent Form	Consent Form	Attachment C 2016_7_18_UAD_Community dialogue_Consent Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Facilitator Guide	Facilitator Guide	Attachment D 2016_7_19_UAD Community dialogue_Focus Group Guide.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	88	88
Annual IC Time Burden (Hours)	64	64
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Transmittal Letter	TransLet-8doc.doc	07/25/2016
Justification	2016_07_25_OMB 2016_Package_UAD_Community conversations_Focus Group.docx	07/25/2016

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