Participant Focus Group Information Form

NHE Demo Opioid Evaluation

Documents and Forms

Document Name Document Type
Participant Focus Group Information Form.docx Other-Focus Group Background Informa
Participant Focus Group Information Form.docx Focus Group Information Form IC Document

Information Collection (IC) Details

IC Title:	Participant Focus Group Information Form	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
Other-Focus Group Background Information Form			Participant Focus Group Information Form.docx		No		Fillable Printable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	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	20	20
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Focus Group Information Form	Participant Focus Group Information Form.docx	08/10/2020

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