Information Collection

Incentive distribution log for focus group participants

IC 213302 under ICR 201409-0925-004 · OMB 0925-0712.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0712 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 7 Incentive distribution log for focus group participants	Form
7 Incentive distribution log for focus group participants Attachment 14 incentive distribution log for focus group participants 952014.docx	Form

IC Title:

Incentive distribution log for focus group participants

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	7	Incentive distribution log for focus group participants	Attachment 14 incentive distribution log for focus group participants 952014.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 63

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	63	63
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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