Information Collection

Foundational Focus Groups

IC 245351 under ICR 202101-0990-004 · OMB 0990-0476.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0476 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Part A - Attachment D_Foundational FGs Invitation Emails.docx	Other-FFG- Part A, Attachment D
Part A - Attachment E_ Foundational FGs Screener_122420.docx	Other-FFG-Part A, Attachment E
Part A - Attachment F_Foundational FGs Informed Consent Form_122420.docx	Other-FFG-Part A, Attachment F
Part A - Attachment G_Foundational FGs External IRB Determination.pdf	Other-FFG-Part A, Attachment G
Part B - Attachment B_Foundational FGs Discussion Guide_011821.docx	Other-FFG-Part B, Attachment B

IC Title:

Foundational Focus Groups

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-FFG- Part A, Attachment D	Part A - Attachment D_Foundational FGs Invitation Emails.docx	Yes	Yes	Fillable Fileable
Other-FFG-Part A, Attachment E	Part A - Attachment E_ Foundational FGs Screener_122420.docx	Yes	Yes	Fillable Fileable
Other-FFG-Part A, Attachment F	Part A - Attachment F_Foundational FGs Informed Consent Form_122420.docx	Yes	Yes	Fillable Fileable
Other-FFG-Part A, Attachment G	Part A - Attachment G_Foundational FGs External IRB Determination.pdf	Yes	Yes	Fillable Fileable
Other-FFG-Part B, Attachment B	Part B - Attachment B_Foundational FGs Discussion Guide_011821.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	3,096	3,096
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.