Focus Groups

Primary and Behavioral Health Care Integration Evaluation

Documents and Forms

Document Name Document Type
Form Electronic Data Co Focus Groups Form and Instruction
Electronic Data Co Electronic Data Collection Tool Attachment E Client Focus Group Guide_FINAL DRAFT FOR OMB.docx Form and Instruction
Attachment K Consent Form for Client Focus Group_FINAL DRAFT FOR OMB.docx Consent Form for Client Focus Group IC Document

Information Collection (IC) Details

IC Title:	Focus Groups	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Electronic Data Collection Tool	Electronic Data Collection Tool	Attachment E Client Focus Group Guide_FINAL DRAFT FOR OMB.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	240	240
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Consent Form for Client Focus Group	Attachment K Consent Form for Client Focus Group_FINAL DRAFT FOR OMB.docx	06/27/2016

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