Information Collection

Case Study Protocol/Focus Groups

IC 213731 under ICR 201406-0930-006 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Case Study Protoco Case Study Protocol/Focus Groups	Form and Instruction
Case Study Protoco Case Study Protocol/Focus Groups Attachment 2-Case Study Protocol for TA Network.docx	Form and Instruction
TA Network Supporting Statement CQI Final.docx Supporting Satement	IC Document
Attachment 3-IRB Determination Letter.pdf IRB	IC Document

IC Title:

Case Study Protocol/Focus Groups

Agency IC Tracking Number:

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	Case Study Protocol/Focus Groups	Case Study Protocol/Focus Groups	Attachment 2-Case Study Protocol for TA Network.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

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
Supporting Satement	TA Network Supporting Statement CQI Final.docx	11/04/2014
IRB	Attachment 3-IRB Determination Letter.pdf	11/04/2014

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