HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups)

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

OMB: 0915-0212

IC ID: 259013

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups)
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Focus Group Moderators Guide Focus Group Guide.docx Yes Yes Fillable Fileable
Form and Instruction 3 Informed Consent Informed Consent.docx Yes Yes Fillable Fileable
Form and Instruction 2 Screening Questions Screening Questions.docx Yes Yes Fillable Fileable

Health Health Care Services

 

54 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 54 0 0 0 0 54
Annual IC Time Burden (Hours) 95 0 0 0 0 95
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Fast Track Memo 05092023 - Fast Track Memo - Generic Clearance - OMB 0915-0212 - 020620235007.docx 05/11/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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