Information Collection

Discussion on Teen Organ Donors

IC 221887 under ICR 201502-0915-002 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Discussion on Teen Organ Donors	Form and Instruction
1 Attachment 1 Focus Group Informed Consent 20160324 Attachment 1_Focus Group Informed Consent_FinalDraft.docx	Form and Instruction
2 Attachment 2 Focus Group Participant Screener 20160324 Attachment 2__FocusGroup_ParticipantScreener_FinalDraft.docx	Form and Instruction
3 Attachment 4 Survey Screener and Questionnaire 20160324 Attachment 4_Survey _Screener and Questionnaire_FinalDraft.docx	Form and Instruction
SupportingStatement_TeenDonor_FinalDraft.docx Supporting Statement	IC Document
Attachment 3 _FocusGroup_ModeratorGuide_FinalDraft.docx Attachment 3 - Focus Group Moderator Guide	IC Document
IRB Question.msg IRB Question	IC Document

IC Title:

Discussion on Teen Organ Donors

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
Form and Instruction	1	Attachment 1 Focus Group Informed Consent	20160324 Attachment 1_Focus Group Informed Consent_FinalDraft.docx	No	Paper Only
Form and Instruction	2	Attachment 2 Focus Group Participant Screener	20160324 Attachment 2__FocusGroup_ParticipantScreener_FinalDraft.docx	No	Paper Only
Form and Instruction	3	Attachment 4 Survey Screener and Questionnaire	20160324 Attachment 4_Survey _Screener and Questionnaire_FinalDraft.docx	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 124

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	124	124
Annual IC Time Burden (Hours)	71	71
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	SupportingStatement_TeenDonor_FinalDraft.docx	06/10/2016
Attachment 3 - Focus Group Moderator Guide	Attachment 3 _FocusGroup_ModeratorGuide_FinalDraft.docx	06/10/2016
IRB Question	IRB Question.msg	06/10/2016

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