Information Collection

Focus Groups

IC 221370 under ICR 201605-0938-003 · OMB 0938-1300.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1300 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
7. FGRecruitmentScript_HIP 2.0_508_19July2016.docx	Other-Telephone Recruitment Script
8. FGModGuide_HIP2.0_16July2016 v.2.docx	Other-CORE Focus Group Moderator’s G
CMS-10615 Participant Informed Consent 11. Focus Group Participant Informed Consent - HIP 2.0 [rev 07-21-2016 by OSORA PRA]508.docx	Form and Instruction
19. HIP2.0FocusGroupModeratorGuideCrosswalk_16July2016.xlsx Mooderator's Guide Crosswalk	IC Document

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Other-Telephone Recruitment Script			7. FGRecruitmentScript_HIP 2.0_508_19July2016.docx	No	Fillable Printable
Other-CORE Focus Group Moderatorâs Guide			8. FGModGuide_HIP2.0_16July2016 v.2.docx	No	Paper Only
Form and Instruction	CMS-10615	Participant Informed Consent	11. Focus Group Participant Informed Consent - HIP 2.0 [rev 07-21-2016 by OSORA PRA]508.docx	No	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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	40	40
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Mooderator's Guide Crosswalk	19. HIP2.0FocusGroupModeratorGuideCrosswalk_16July2016.xlsx	07/20/2016

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