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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.