Information Collection

Consumer Audience Feedback Activity

IC 247686 under ICR 202111-0925-001 · OMB 0925-0769.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0769 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Consumer Audience Feedback Activity	Form and Instruction
Form 3 Moderators Guide for Discussion with Consumers Consumer Audience Feedback Activity	Form and Instruction
Form 5 Audience Feedback Team Sample Online Bulletin Board Prompt Consumer Audience Feedback Activity	Form and Instruction
3 Moderators Guide for Discussion with Consumers Attachment 3 - Moderators Guide for Discussions with Consumers updated 061721.docx	Form and Instruction
3 Moderators Guide for Discussion with Consumers Attachment 3 - Moderators Guide for Discussions with Consumers updated 061721.docx	Form and Instruction
5 Audience Feedback Team Sample Online Bulletin Board Prom Attachment 5 - Audience Feedback Team Sample Online Bulletin Board Prompt updated 061721.docx	Form and Instruction
5 Audience Feedback Team Sample Online Bulletin Board Prom Attachment 5 - Audience Feedback Team Sample Online Bulletin Board Prompt updated 061721.docx	Form and Instruction

IC Title:

Consumer Audience Feedback Activity

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3	Moderators Guide for Discussion with Consumers	Attachment 3 - Moderators Guide for Discussions with Consumers updated 061721.docx		No		Paper Only
Form and Instruction	5	Audience Feedback Team Sample Online Bulletin Board Prompt	Attachment 5 - Audience Feedback Team Sample Online Bulletin Board Prompt updated 061721.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

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	480	480
Annual IC Time Burden (Hours)	480	480
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.