Information Collection

Risk and Benefit Perception Scale Development Focus Groups

IC 205791 under ICR 201404-0910-001 · OMB 0910-0497.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0497 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A_Screener.docx	Other-Screener
Appendix B_Moderator Guide.docx	Other-Moderator Guide
Appendix C_Consent Form.docx	Other-Consent Form
OMB Justification memo.doc OMB Justification memo	IC Document

IC Title:

Risk and Benefit Perception Scale Development Focus Groups

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screener	Appendix A_Screener.docx	Yes	Yes	Fillable Printable
Other-Moderator Guide	Appendix B_Moderator Guide.docx	Yes	Yes	Fillable Printable
Other-Consent Form	Appendix C_Consent Form.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 360

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	360	360
Annual IC Time Burden (Hours)	189	189
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Justification memo	OMB Justification memo.doc	02/11/2013

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