Information Collection

Patient Focus Group Interview - Small Group Discussion Interview Guide

IC 208619 under ICR 201309-0915-001 · OMB 0915-0371.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Patient Focus Group Interview - Small Group Discussion Interview Guide	Form and Instruction
1 Small Group Discussion Guide AppendixC_SmallGroupDiscussionGuide.docx	Form and Instruction
2 AppendixS_SampleTextMessageInventory.docx 2 AppendixS_SampleTextMessageInventory	IC Document
2 AppendixR_SmallGroupDiscussionReminderEmail.docx 2 AppendixR_SmallGroupDiscussionReminderEmail	IC Document
AppendixK_1 Adolescent assent form for small group.docx AppendixK_1 Adolescent assent form for small group	IC Document
AppendixK_2 Adult consent form for small group.docx AppendixK_2 Adult consent form for small group	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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
Form and Instruction	1	Small Group Discussion Guide	AppendixC_SmallGroupDiscussionGuide.docx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 32

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	32	32
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
2 AppendixS_SampleTextMessageInventory	2 AppendixS_SampleTextMessageInventory.docx	08/30/2013
2 AppendixR_SmallGroupDiscussionReminderEmail	2 AppendixR_SmallGroupDiscussionReminderEmail.docx	08/30/2013
AppendixK_1 Adolescent assent form for small group	AppendixK_1 Adolescent assent form for small group.docx	08/30/2013
AppendixK_2 Adult consent form for small group	AppendixK_2 Adult consent form for small group.docx	08/30/2013

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