Information Collection

Health Benefits Focus Group

IC 221516 under ICR 201510-2090-001 · OMB 2090-0028.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2090-0028 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2205.18 Health Benefits Focus Group Script.docx	Other-Other
health benefit IC_script_09272016_clean.docx	Other-focus group script
2205ss18 Health Benefits Generic.docx 2205ss18 Health Benefits Generic	IC Document
health benefit IC_supporting statement_09282016_clean.docx Supporting statement	IC Document

IC Title:

Health Benefits Focus Group

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
Other-focus group script			health benefit IC_script_09272016_clean.docx		No		Paper Only
Other-Other			2205.18 Health Benefits Focus Group Script.docx		No		Paper Only

Line of Business: Environmental Management

Subfunction: Environmental Monitoring and Forecasting

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

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	100	100
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2205ss18 Health Benefits Generic	2205ss18 Health Benefits Generic.docx	05/13/2016
Supporting statement	health benefit IC_supporting statement_09282016_clean.docx	09/28/2016

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