Virtual Focus Groups with Primary Care Physicians and OBGYNs

Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.