Focus Group Questionnaire

ConnectHome Use and Barriers Focus Groups

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Focus Group Questionnaire	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
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 %

	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

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.