Information Collection

2015 Focus Group Testing with General Public

IC 217174 under ICR 201408-0920-009 · OMB 0920-0800.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0800 can be found here:

Documents and Forms

Document Name Document Type
2015 Focus Group Testing with General Public Form and Instruction
Screener and Recruitment Att B-1. Screening and Recruitment Form_English_6 22 2015.doc Form and Instruction
Screener and Recruitment - Spanish Att B-2. Screening and Recruitment Form_Spanish_6 22 2015.doc Form and Instruction
Focus Group Guide Att A-1. Focus Group Discussion Guide_English_6 22 2015.doc Form and Instruction
Focus Group Guide - Spanish Att A-2. Focus Group Discussion Guide_Spanish_6 22 2015.doc Form and Instruction
SS A. 2015 Screen For Life _6 22 2015.doc Supporting Statement A IC Document
SS B. 2015 Screen for Life_6 22 2015.docx Supporting Statement B IC Document
Att C-1. Consent Form English _6 22 2015.doc Consent IC Document
Att C-2. Consent Form_Spanish_6 22 2015.docx Consent - Spanish IC Document
Att D. Creative Concepts Brief_6 22 2015.doc Creative Concepts IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	2015 Focus Group Testing with General Public	Agency IC Tracking Number:	15ARO

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Focus Group Guide	Att A-1. Focus Group Discussion Guide_English_6 22 2015.doc	Yes	No	Paper Only
Form and Instruction	none	Focus Group Guide - Spanish	Att A-2. Focus Group Discussion Guide_Spanish_6 22 2015.doc	Yes	No	Paper Only
Form and Instruction	none	Screener and Recruitment	Att B-1. Screening and Recruitment Form_English_6 22 2015.doc	Yes	No	Fillable Printable
Form and Instruction	none	Screener and Recruitment - Spanish	Att B-2. Screening and Recruitment Form_Spanish_6 22 2015.doc	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 756	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	756	756
Annual IC Time Burden (Hours)	529	529
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	SS A. 2015 Screen For Life _6 22 2015.doc	06/24/2015
Supporting Statement B	SS B. 2015 Screen for Life_6 22 2015.docx	06/24/2015
Consent	Att C-1. Consent Form English _6 22 2015.doc	06/24/2015
Consent - Spanish	Att C-2. Consent Form_Spanish_6 22 2015.docx	06/24/2015
Creative Concepts	Att D. Creative Concepts Brief_6 22 2015.doc	06/24/2015

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