Information Collection

Synchronous Focus Group Consent - Clinician and Healthcare Professionals

IC 254877 under ICR 202103-0955-002 · OMB 0955-0021.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form D3 Final Synchronous Focus Group Consent-Clinicians and Healthcare Professionals Synchronous Focus Group Consent - Clinician and Healthcare Professionals	Form
D3 Final Synchronous Focus Group Consent-Clinicians and Hea Attachment D3. Final Synchronous Focus Group Consent-Clinicians and Healthcare Professionals.docx	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	D3				Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	10	10
Annual IC Time Burden (Hours)	1	1
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.

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