Information Collection

Focus Group Recruitment Screener for Poison Control Center Staff

IC 209783 under ICR 201312-0923-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att4b_FocGrp_RecScrnr_PCCStaff.doc	Other-WORD
Att3b_Intro_Email_FocGrps.docx Att3b_Intro_Email_FocGrps	IC Document
Att5b_Conf_Email_FocGrps.docx Att5b_Conf_Email_FocGrps	IC Document
Att6a_Remind_Email_Ints.docx Att6a_Remind_Email_Ints	IC Document
Att10a_Inf_Cnsnt_FocGrps.docx Att10a_Inf_Cnsnt_FocGrps	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
Other-WORD			Att4b_FocGrp_RecScrnr_PCCStaff.doc		Yes	Yes	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 36

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att3b_Intro_Email_FocGrps	Att3b_Intro_Email_FocGrps.docx	12/13/2013
Att5b_Conf_Email_FocGrps	Att5b_Conf_Email_FocGrps.docx	12/13/2013
Att6a_Remind_Email_Ints	Att6a_Remind_Email_Ints.docx	12/13/2013
Att10a_Inf_Cnsnt_FocGrps	Att10a_Inf_Cnsnt_FocGrps.docx	12/16/2013

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