Information Collection

CCC Partners TA Provider Focus Group Guide

IC 210390 under ICR 201402-0920-012 · OMB 0920-1016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1016 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920- Att E1_TA_Provider_Focus_Group_Guide CCC Partners TA Provider Focus Group Guide	Form and Instruction
0920- Att E1_TA_Provider_Focus_Group_Guide Att E1_TA_Provider_Focus_Group_Guide_10_29_13.docx	Form and Instruction
Att E2_TA Provider Focus_Group_Invitation_11_01_13.docx Att E2_TA Provider Focus_Group_Invitation	IC Document

IC Title:

CCC Partners TA Provider Focus Group Guide

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	0920-				Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	15	15
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att E2_TA Provider Focus_Group_Invitation		02/11/2014

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

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