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Federal forms, ICRs, and supporting documents

Information Collection

HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach

IC 243367 under ICR 202012-0915-001 · OMB 0915-0212.

Documents and Forms
Document Name
Document Type
Other-Screener
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 FORM Focus Group CLEAN.docx FORM Focus Group CLEAN.docx Yes Yes Fillable Fileable
Other-Screener FORM Focus Group Screener - CLEAN.docx Yes No Paper Only
Form and Instruction 2 FORM Survey Questions CLEAN.docx FORM Survey Questions CLEAN.docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

896 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 896 0 0 0 0 896
Annual IC Time Burden (Hours) 301 0 0 0 0 301
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A FINAL Supporting Statement - Formative Eval Minority Outreach Generic.docx 08/28/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.