Information Collection

Foundational Focus Groups

IC 245351 under ICR 202109-0990-011 · OMB 0990-0476.

⚠️ Notice: This information collection may be referencing outdated material.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

2023-06-13 - No material or nonsubstantive change to a currently approved collection
2023-06-05 - No material or nonsubstantive change to a currently approved collection

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 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 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 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 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
Part B - Attachment B_Foundational FGs Discussion Guide_011821.docx	Other-FFG-Part B, Attachment B
BRCFB8~1.PDF	Other-Screener - Definite Waiters
BRCFB8~1.PDF	Other-Screener - Definite Waiters
BRANYI~2.PDF	Other-Screener - American Indian
BRANYI~2.PDF	Other-Screener - American Indian
BRANYI~3.PDF	Other-Screener - Asian american
BRANYI~3.PDF	Other-Screener - Asian american
BRANYI~4.PDF	Other-Screener - African American
BRANYI~4.PDF	Other-Screener - African American
BR1E56~1.PDF	Other-Screener - Hispanic
BR1E56~1.PDF	Other-Screener - Hispanic
BR6545~1.PDF	Other-Screener - Native Hawaiian
BR6545~1.PDF	Other-Screener - Native Hawaiian
BR250A~1.PDF	Other-Screener - Unsure Waiters
BR250A~1.PDF	Other-Screener - Unsure Waiters
BR91F4~1.PDF	Other-Screener - Vaccinated Gen Pop
BR91F4~1.PDF	Other-Screener - Vaccinated Gen Pop
HHS COVID-19 Creative Testing Wave 2 Screener July 12_clean.docx	Other-Testing-Screener-7-12-21
HHS COVID-19 Creative Testing Wave 2 Screener July 12_clean.docx	Other-Testing-Screener-7-12-21

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Foundational Focus Groups

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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
Other-Screener - Definite Waiters	BRCFB8~1.PDF	Yes	Yes	Fillable Fileable
Other-Screener - American Indian	BRANYI~2.PDF	Yes	Yes	Fillable Fileable
Other-Screener - Asian american	BRANYI~3.PDF	Yes	Yes	Fillable Fileable
Other-Screener - African American	BRANYI~4.PDF	Yes	Yes	Fillable Fileable
Other-Screener - Hispanic	BR1E56~1.PDF	Yes	Yes	Fillable Fileable
Other-Screener - Native Hawaiian	BR6545~1.PDF	Yes	Yes	Fillable Fileable
Other-Screener - Unsure Waiters	BR250A~1.PDF	Yes	Yes	Fillable Fileable
Other-Screener - Vaccinated Gen Pop	BR91F4~1.PDF	Yes	Yes	Fillable Fileable
Other-Testing-Screener-7-12-21	HHS COVID-19 Creative Testing Wave 2 Screener July 12_clean.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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	Previously Approved
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.