Information Collection

Intervention Resources Concept Testing

IC 224938 under ICR 201608-0930-002 · OMB 0930-0196.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0196 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Intervention Resou Intervention Resources Concept Testing	Form and Instruction
Intervention Resou Intervention Resources Focus Group Protocol FINAL_Attachment A - Intervention Resources Focus Group Protocol (002).docx	Form and Instruction
Screening and recr Screening and recruitment FINAL_Attachment B - Intervention Resources screening and recruitme. (00....docx	Form and Instruction
FINAL_Attachment C - Intervention Resources Consent Form (002).docx Consent Form	IC Document
FINAL_Attachment D - Intervention Resources Focus Group Facilitator Guid....docx Guide - Parents of Active/Recovering	IC Document
FINAL_Attachment E - Intervention Resources Focus Group Facilitator Guid....docx Guide - Bereaved Parents	IC Document
FINAL_Attachment F - Intervention Resources Focus Group Facilitator Guid....docx Guide - Young Adults	IC Document
FINAL_Intervention Resources OMB package_Supporting Statements (002).docx Justification	IC Document
TransLet-2doc.doc Transmittal Letter	IC Document

IC Title:

Intervention Resources Concept Testing

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
Form and Instruction	Intervention Resources Focus Group Protocol	Intervention Resources Focus Group Protocol	FINAL_Attachment A - Intervention Resources Focus Group Protocol (002).docx		Yes	Yes	Fillable Fileable
Form and Instruction	Screening and recruitment	Screening and recruitment	FINAL_Attachment B - Intervention Resources screening and recruitme. (00....docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	108	108
Annual IC Time Burden (Hours)	77	77
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent Form	FINAL_Attachment C - Intervention Resources Consent Form (002).docx	12/22/2016
Guide - Parents of Active/Recovering	FINAL_Attachment D - Intervention Resources Focus Group Facilitator Guid....docx	12/22/2016
Guide - Bereaved Parents	FINAL_Attachment E - Intervention Resources Focus Group Facilitator Guid....docx	12/22/2016
Guide - Young Adults	FINAL_Attachment F - Intervention Resources Focus Group Facilitator Guid....docx	12/22/2016
Justification	FINAL_Intervention Resources OMB package_Supporting Statements (002).docx	12/22/2016
Transmittal Letter	TransLet-2doc.doc	12/22/2016

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