Information Collection

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

IC 225607 under ICR 201702-0920-003 · OMB 0920-1164.

Documents and Forms

Documents and forms in this information collection
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

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?	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 %

table that charts list of burden
	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

table that charts IC Documents
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.