Information Collection

Focus Group Moderator Guide for Emergency Department Personnel

IC 209790 under ICR 201312-0923-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att7_FocGrp_Mod_Guide.doc	Other-WORD
Att9c_Mod_Agree_Form.doc Att9c_Mod_Agree_Form	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			Att7_FocGrp_Mod_Guide.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)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att9c_Mod_Agree_Form	Att9c_Mod_Agree_Form.doc	12/16/2013

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