Information Collection

Focus Group-Facility Administrators and Staff

IC 242979 under ICR 202008-0985-001 · OMB 0985-0069.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Focus Group-Facility Administrators and Staff	Form and Instruction
0985-New Draft Focus Group Guide_Facility Staff (7).pdf	Other-Focus Group Guide
Facility Administrator Survey 0985-New Draft Survey_Facility Administrator (3).pdf	Form and Instruction
Focus Group-Facility Staff 0985-New Draft Focus Group Participant Info_Facility Staff (8).pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	NA	Facility Administrator Survey	0985-New Draft Survey_Facility Administrator (3).pdf	Yes	Yes	Fillable Fileable
Other-Focus Group Guide			0985-New Draft Focus Group Guide_Facility Staff (7).pdf	Yes	Yes	Fillable Fileable
Form	NA	Focus Group-Facility Staff	0985-New Draft Focus Group Participant Info_Facility Staff (8).pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,856

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,856	1,856
Annual IC Time Burden (Hours)	612	612
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.