Information Collection

Healthy Brain Focus Group

IC 213108 under ICR 201307-0925-006 · OMB 0925-0678.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NINDS-Brain-Health-Moderator-Guide-8-26-14.doc	Instruction
1 NINDS HEALTHY BRAIN FOCUS GROUP SCREENER NINDS-Screener-9-9-14.doc	Form and Instruction
NINDS fast-track-template-8-6-14.doc Fast-Track template NINDS Healthy Brain Focus Group	IC Document
Concept Materials for OMB Review 9-9-14.pdf Concept Materials	IC Document

IC Title:

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			NINDS-Brain-Health-Moderator-Guide-8-26-14.doc		No		Paper Only
Form and Instruction	1	NINDS HEALTHY BRAIN FOCUS GROUP SCREENER	NINDS-Screener-9-9-14.doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54

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	54	54
Annual IC Time Burden (Hours)	81	81
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast-Track template NINDS Healthy Brain Focus Group	NINDS fast-track-template-8-6-14.doc	09/15/2014
Concept Materials	Concept Materials for OMB Review 9-9-14.pdf	09/15/2014

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