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

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.