Provider Focus Group - ASD

Effective Communication in Public Health Emergencies – Developing Community-Centered Tools for People with Special Health Care Needs

Documents and Forms

Document Name Document Type
Provider Focus Group - ASD Form and Instruction
ASD Provider Focus Group Attachment R. ASD Provider Focus Group.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Provider Focus Group - ASD	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
Form and Instruction	NA	ASD Provider Focus Group	Attachment R. ASD Provider Focus Group.docx	NA	No		Paper Only

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	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	10	10
Annual IC Time Burden (Hours)	15	15
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.