Information Collection

Mini Focus Groups to Garner Feedback to the National Institute on Aging's Advance Care Planning Conversation Guide (NIA)

IC 250849 under ICR 202307-0925-002 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Mini Focus Groups to Garner Feedback to the National Institute on Aging's Advance Care Planning Conversation Guide (NIA)	Form and Instruction
1 Recruitment screener Attachment 1_Recruitment Screener-Final-v2.docx	Form and Instruction
2 Moderator's Guide Attachment 2_Moderator's Guide-Final (2).docx	Form and Instruction
NIA_ACP Conversation Guide-OMB Fast Track Form_12.10.21_Final.docx fast track for mini focus group	IC Document
Attachment 3_ACP Conversation Guide (2).docx ACP Conversation Guide	IC Document

IC Title:

Mini Focus Groups to Garner Feedback to the National Institute on Aging's Advance Care Planning Conversation Guide (NIA)

Agency IC Tracking Number:

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	1	Recruitment screener	Attachment 1_Recruitment Screener-Final-v2.docx		No		Paper Only
Form and Instruction	2	Moderator's Guide	Attachment 2_Moderator's Guide-Final (2).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: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	37	37
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
fast track for mini focus group	NIA_ACP Conversation Guide-OMB Fast Track Form_12.10.21_Final.docx	12/20/2021
ACP Conversation Guide	Attachment 3_ACP Conversation Guide (2).docx	12/20/2021

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