Information Collection

Virtual Focus Groups with Primary Care Physicians and OBGYNs

IC 238539 under ICR 201808-0920-023 · OMB 0920-0840.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0840 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0840 Virtual Focus Groups with Primary Care Physicians and OBGYNs	Form and Instruction
Attachment 4 - Consent Form 082119.docx	Other-WORD
0920-0840 Recruitment Screener Attachment 3 - Recruitment Screener 080119.docx	Form and Instruction
0920-0840 DISCUSSION GUIDE: Virtual Focus Groups with Primary Care Attachment 7 - Discussion Guide 080119.docx	Form
SS A.docx Supporting Statement A	IC Document
SS B 082119.docx Supporting Statement B	IC Document
Attachment 1 - Authorizing Legislation 080119.docx Att 1_Autho Leg	IC Document
Attachment 2 - Initial Recruitment Email 080119.docx Att 2_Initial Recruitment Email	IC Document
Attachment 5 - Focus Group Participation Confirmation Letter 080119.docx Att 5_Focus Group Participation Confirmation	IC Document
Attachment 6 - Focus Group Recruitment Spreadsheet 080119.docx Att 6_ Focus Group Recruitment Spreadsheet	IC Document
Attachment 8 - IRB Approval Certification.pdf Att 8_IRB Approval	IC Document
Attachment 9_DataManagementPlan.docx Att 9_Data Management Plan	IC Document
Attachment 10_PIA_1019.pdf Att 10_PIA	IC Document

IC Title:

Virtual Focus Groups with Primary Care Physicians and OBGYNs

Agency IC Tracking Number:

0920-0840-20CL

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0840	Recruitment Screener	Attachment 3 - Recruitment Screener 080119.docx	No		Printable Only
Other-WORD			Attachment 4 - Consent Form 082119.docx	No		Printable Only
Form	0920-0840	DISCUSSION GUIDE: Virtual Focus Groups with Primary Care Physicians and OBGYNs: Attitudes about Proposed Hepatitis C Screening Guidelines DVH 2019	Attachment 7 - Discussion Guide 080119.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 528

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	528	528
Annual IC Time Burden (Hours)	233	233
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	SS A.docx	11/20/2019
Supporting Statement B	SS B 082119.docx	11/14/2019
Att 1_Autho Leg	Attachment 1 - Authorizing Legislation 080119.docx	11/14/2019
Att 2_Initial Recruitment Email	Attachment 2 - Initial Recruitment Email 080119.docx	11/14/2019
Att 5_Focus Group Participation Confirmation	Attachment 5 - Focus Group Participation Confirmation Letter 080119.docx	11/14/2019
Att 6_ Focus Group Recruitment Spreadsheet	Attachment 6 - Focus Group Recruitment Spreadsheet 080119.docx	11/14/2019
Att 8_IRB Approval	Attachment 8 - IRB Approval Certification.pdf	11/14/2019
Att 9_Data Management Plan	Attachment 9_DataManagementPlan.docx	11/14/2019
Att 10_PIA	Attachment 10_PIA_1019.pdf	11/14/2019

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