Information Collection

Discussion Guide

IC 224799 under ICR 201612-0920-006 · OMB 0920-1179.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Discussion Guide	Form and Instruction
Discussion Guide Attachment E- Discussion Guide_112316.docx	Form and Instruction
Attachment F- Activity Worksheet Profile of an Excessive Drinker_112316.docx Att F_Activity Worksheet: Profile of an Excessive Drinker	IC Document
Attachment G- Activity Worksheet Excessive Drinking Problems_112316.docx Att G_Activity Worksheet: Excessive Drinking Problems	IC Document
Attachment H- Alcohol Definitions Stimuli_112316.pdf Att H_Stimuli: Alcohol Consumption Definitions	IC Document

IC Title:

Discussion Guide

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
Form and Instruction	N/A	Discussion Guide	Attachment E- Discussion Guide_112316.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 72

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	72	72
Annual IC Time Burden (Hours)	108	108
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att F_Activity Worksheet: Profile of an Excessive Drinker	Attachment F- Activity Worksheet Profile of an Excessive Drinker_112316.docx	12/12/2016
Att G_Activity Worksheet: Excessive Drinking Problems	Attachment G- Activity Worksheet Excessive Drinking Problems_112316.docx	12/12/2016
Att H_Stimuli: Alcohol Consumption Definitions	Attachment H- Alcohol Definitions Stimuli_112316.pdf	12/12/2016

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