Focus Groups

Healthy Indiana Program (HIP) 2.0 Beneficiary Focus Groups and Informational Interviews (CMS-10615)

OMB: 0938-1300

IC ID: 221370

Documents and Forms
Document Name
Document Type
Other-Telephone Recruitment Script
Other-CORE Focus Group Moderator’s G
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Focus Groups
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Telephone Recruitment Script 7. FGRecruitmentScript_HIP 2.0_508_19July2016 (rev 09-28-2016).docx No   Fillable Printable
Form and Instruction CMS-10615 Participant Informed Consent 11. Focus Group Participant Informed Consent - HIP 2.0 [rev 07-21-2016 by OSORA PRA]508 (rev 09-29-2016).docx No   Fillable Fileable Signable
Other-CORE Focus Group Moderator’s Guide 9.FGModGuide_HIP2.0_508 03.13.18 clean.docx No   Paper Only

Health Health Care Services

 

80 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 80 0 0 0 0 80
Annual IC Time Burden (Hours) 240 0 0 0 0 240
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Mooderator's Guide Crosswalk 9.FGModGuide_HIP2.0_508 03.13.18 redline.docx 03/30/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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