Focus Group Guide - Women 18 years or older / able to conceive

Monitoring & Evaluation for the Zika Contraception Access Network (Z-CAN)

Documents and Forms

Document Name Document Type
Focus Group Guide - Women 18 years or older / able to conceive Form and Instruction
Focus Group Guide - Z-CAN Women English Att H-1 FGD guide_ZCAN women (Eng).docx Form and Instruction
Focus Group Guide Z-CAN Women Spanish Att H-2 FGD guide_ZCAN women (Span).docx Form and Instruction
Focus Group Guide - Non-Z-CAN Women English Att H-3 FGD guide_non ZCAN women (Eng).docx Form and Instruction
Focus Group Guide Non-Z-CAN Women Spanish Att H-4 FGD guide_non ZCAN women (Span).docx Form and Instruction

Information Collection (IC) Details

IC Title:	Focus Group Guide - Women 18 years or older / able to conceive	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?	Electronic Capability
Form and Instruction	NA	Focus Group Guide - Z-CAN Women English	Att H-1 FGD guide_ZCAN women (Eng).docx	NA	No	Paper Only
Form and Instruction	NA	Focus Group Guide Z-CAN Women Spanish	Att H-2 FGD guide_ZCAN women (Span).docx	NA	No	Paper Only
Form and Instruction	NA	Focus Group Guide - Non-Z-CAN Women English	Att H-3 FGD guide_non ZCAN women (Eng).docx	NA	No	Paper Only
Form and Instruction	NA	Focus Group Guide Non-Z-CAN Women Spanish	Att H-4 FGD guide_non ZCAN women (Span).docx	NA	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 240	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	240	240
Annual IC Time Burden (Hours)	360	360
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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