Focus Group Eligibility Screen

HHS Office on Women's Health State-Level Paid Family Leave Policy Project

Documents and Forms

Document Name Document Type
Document_1_Focus_Group_Screener_3_25_2019.docx Instruction

Information Collection (IC) Details

IC Title:	Focus Group Eligibility Screen	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
Instruction			Document_1_Focus_Group_Screener_3_25_2019.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 384	Number of Respondents for Small Entity: 384

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	384	384
Annual IC Time Burden (Hours)	96	96
Annual IC Cost Burden (Dollars)	1,915	1,915

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.