Information Collection

NEI Health Focus Groups with New Audiences Ages 25-35

IC 230574 under ICR 201501-0925-004 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NEI Health Focus Groups with New Audiences Ages 25-35	Form and Instruction
1 NEI Screener Attachment A-NEI-OMB-Screener_New_Aud_FG_2018-03-07.docx	Form and Instruction
2 NEI Mod Guide Attachment B-NEI-OMB-Mod_Guide_New_Aud_FG_2018-03-07.docx	Form and Instruction
Generic_Clearance_Request_NEI_OMB_New_Aud_FG_Rev_2018-03-07.doc NEI Health Focus Group with New Audiences Ages 25-35	IC Document

IC Title:

NEI Health Focus Groups with New Audiences Ages 25-35

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	1	NEI Screener	Attachment A-NEI-OMB-Screener_New_Aud_FG_2018-03-07.docx		No		Paper Only
Form and Instruction	2	NEI Mod Guide	Attachment B-NEI-OMB-Mod_Guide_New_Aud_FG_2018-03-07.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 288

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	288	288
Annual IC Time Burden (Hours)	173	173
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NEI Health Focus Group with New Audiences Ages 25-35	Generic_Clearance_Request_NEI_OMB_New_Aud_FG_Rev_2018-03-07.doc	03/07/2018

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