Information Collection

NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides

IC 214693 under ICR 201410-0925-002 · OMB 0925-0643.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0643 can be found here:

2017-11-13 - Reinstatement without change of a previously approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Focus Group Guide GENERAL PROVIDERS NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction
Form 2 Focus Group Guide HEALTH PROVIDERS NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction
Form 3 Focus Group Guide ELDERS NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction
Form 4 Focus Group Guide FATHERS NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction
Form 5 Focus Group Guide MOTHERS NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides	Form and Instruction
0925-0643_HNB_focus_group_Family_RECRUITMENT_SCREENER rev_1-7-15.docx	Other-Screener
0925-0643_HNB_focus_group_professionals_RECRUITMENT_SCREENER rev_1-7-15.docx	Other-Screener
1 Focus Group Guide GENERAL PROVIDERS 0925-0643_HNB FocusGroupGuide GENERAL Providers rev_1-7-15.docx	Form and Instruction
2 Focus Group Guide HEALTH PROVIDERS 0925-0643_HNB FocusGroupGuide HEALTH Providers rev_1-7-15.docx	Form and Instruction
3 Focus Group Guide ELDERS 0925-0643_HNB FocusGroupGuide ELDERS rev_1-7-15.docx	Form and Instruction
4 Focus Group Guide FATHERS 0925-0643_HNB FocusGroupGuide FATHERS rev_1-7-15.docx	Form and Instruction
5 Focus Group Guide MOTHERS 0925-0643_HNB FocusGroupGuide MOTHERS rev_1-7-15.docx	Form and Instruction
0925-0643_Gen Clearance Template_HNB Focus Group Guides_Indiv-HH rev_1-7-15 (2).doc Generic Clearance Form Healthy Native Babies Project Focus Group	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

NICHD Safe to SleepÂ® Campaign Healthy Native Babies (HNB) Focus Group Guides

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	Available Electronically?	Electronic Capability
Other-Screener			0925-0643_HNB_focus_group_Family_RECRUITMENT_SCREENER rev_1-7-15.docx	No	Paper Only
Other-Screener			0925-0643_HNB_focus_group_professionals_RECRUITMENT_SCREENER rev_1-7-15.docx	No	Paper Only
Form and Instruction	1	Focus Group Guide GENERAL PROVIDERS	0925-0643_HNB FocusGroupGuide GENERAL Providers rev_1-7-15.docx	No	Paper Only
Form and Instruction	2	Focus Group Guide HEALTH PROVIDERS	0925-0643_HNB FocusGroupGuide HEALTH Providers rev_1-7-15.docx	No	Paper Only
Form and Instruction	3	Focus Group Guide ELDERS	0925-0643_HNB FocusGroupGuide ELDERS rev_1-7-15.docx	No	Paper Only
Form and Instruction	4	Focus Group Guide FATHERS	0925-0643_HNB FocusGroupGuide FATHERS rev_1-7-15.docx	No	Paper Only
Form and Instruction	5	Focus Group Guide MOTHERS	0925-0643_HNB FocusGroupGuide MOTHERS rev_1-7-15.docx	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

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	50	50
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Clearance Form Healthy Native Babies Project Focus Group	0925-0643_Gen Clearance Template_HNB Focus Group Guides_Indiv-HH rev_1-7-15 (2).doc	01/20/2015

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