Information Collection

Adolescent Focus Group Protocol

IC 210512 under ICR 201402-0935-001 · OMB 0935-0190.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 13 Adolescent Focus Group Protocol Adolescent Focus Group Protocol	Form and Instruction
13 Adolescent Focus Group Protocol Attachment P- 2014 Adolescent Focus Group Protocol.docx	Form and Instruction
Attachment O- Informed Consent Forms.docx Attachment O- Informed Consent Forms	IC Document
Attachment Q- 2014 Adolescent Focus Group Recruitment Materials.docx Attachment Q- 2014 Adolescent Focus Group Recruitment Materials	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	13				Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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	40	40
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment O- Informed Consent Forms		02/19/2014
Attachment Q- 2014 Adolescent Focus Group Recruitment Materials		02/19/2014

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

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