Information Collection

Educational Outreach Focus Groups with Health Educators (CTP)

IC 248074 under ICR 202206-0910-016 · OMB 0910-0697.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0697 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Initial Email Screener.docx	Other-Initial Email Screener
Initial Email Screener.docx	Other-Initial Email Screener
Informed Consent.docx	Other-Informed Consent
Informed Consent.docx	Other-Informed Consent
Follow-up Phone Screener.docx	Other-Follow up Phone Screener
Follow-up Phone Screener.docx	Other-Follow up Phone Screener
Recruitment Materials.docx	Other-Recruitment Materials
Recruitment Materials.docx	Other-Recruitment Materials
Discussion Guide.docx	Other-Discussion Guide
Discussion Guide.docx	Other-Discussion Guide
0697 OMB Approval Memo - Educational Outreach FG Health Educators 2021.docx OMB Approval Memo	IC Document
0697 OMB Approval Memo - Educational Outreach FG Health Educators 2021.docx OMB Approval Memo	IC Document
IRB Letter.pdf IRB Letter	IC Document
IRB Letter.pdf IRB Letter	IC Document

IC Title:

Educational Outreach Focus Groups with Health Educators (CTP)

Agency IC Tracking Number:

CTP

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-Initial Email Screener	Initial Email Screener.docx	Yes	Yes	Fillable Fileable
Other-Informed Consent	Informed Consent.docx	Yes	Yes	Fillable Fileable
Other-Follow up Phone Screener	Follow-up Phone Screener.docx	Yes	Yes	Fillable Fileable
Other-Recruitment Materials	Recruitment Materials.docx	Yes	No	Printable Only
Other-Discussion Guide	Discussion Guide.docx	Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 378

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	378	378
Annual IC Time Burden (Hours)	212	212
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Approval Memo	0697 OMB Approval Memo - Educational Outreach FG Health Educators 2021.docx	06/28/2021
IRB Letter	IRB Letter.pdf	06/28/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.