Information Collection

Focus Group Questionnaire

IC 222855 under ICR 201608-2528-002 · OMB 2528-0311.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Focus group questionnaire_forOMB_with PRA Notice (Revised_7_13_16) Appendix C.docx	Other-Focus Group Questionnaire
Focus Group Protocols_Subscribers_for OMB Appendix D.docx Focus Group Protocols Subscribers	IC Document
Focus Group Protocols_NonSubscribers_for OMB Appendix E.docx Focus Group Protocols Non-Subscribers	IC Document

IC Title:

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Focus Group Questionnaire			Focus group questionnaire_forOMB_with PRA Notice (Revised_7_13_16) Appendix C.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 165

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	165	165
Annual IC Time Burden (Hours)	247	247
Annual IC Cost Burden (Dollars)	7,425	7,425

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Focus Group Protocols Subscribers	Focus Group Protocols_Subscribers_for OMB Appendix D.docx	08/05/2016
Focus Group Protocols Non-Subscribers	Focus Group Protocols_NonSubscribers_for OMB Appendix E.docx	08/05/2016

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