Information Collection

Case Study: Focus Group

IC 226371 under ICR 201704-0938-003 · OMB 0938-1342.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1342 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10632 Case Study: Explanation of Consent, Short Survey, and Focus Group Facilitation Guide Case Study: Focus Group	Form and Instruction
CMS-10632 Case Study: Explanation of Consent, Short Survey, and Fo CMS-10632.Appendix D - Case Study Explanation of Consent, Short Survey, and Focus Group Facilitation Guide.docx	Form and Instruction

IC Title:

Case Study: Focus Group

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	CMS-10632				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 36

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	36	36
Annual IC Time Burden (Hours)	36	36
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.

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