Information Collection

CCC Partners TA Provider Focus Group Guide

IC 210390 under ICR 201510-0920-001 · OMB 0920-1016.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920- CCC Partners TA Provider Focus Group Guide	Form and Instruction
0920- Att E1_TA_Provider_Focus_Group_Guide Att E1_TA_Provider_Focus_Group_Guide_10_29_13.docx	Form and Instruction
Att E2_TA Provider Focus_Group_Invitation_11_01_13.docx Att E2_TA Provider Focus_Group_Invitation	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	0920-	Att E1_TA_Provider_Focus_Group_Guide	Att E1_TA_Provider_Focus_Group_Guide_10_29_13.docx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att E2_TA Provider Focus_Group_Invitation	Att E2_TA Provider Focus_Group_Invitation_11_01_13.docx	02/11/2014

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