Information Collection

Staff Focus Group

IC 215075 under ICR 201502-0990-005 · OMB 0990-0428.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0428 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-New_PAF Instrument 2_Master Protocol For Small Group Interviews.docx	Other-Guide
0990-_New_PAF_Attachment C_ConsentAssent Forms.docx Consent Letters and Forms and Youth Assent Form for Focus groups	IC Document

IC Title:

Staff Focus Group

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
Other-Guide					No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13

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	13	13
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent Letters and Forms and Youth Assent Form for Focus groups		02/24/2015

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

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