Information Collection

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

IC 259013 under ICR 202312-0915-001 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups)	Form and Instruction
1 Focus Group Moderators Guide Focus Group Guide.docx	Form and Instruction
1 Focus Group Moderators Guide Focus Group Guide.docx	Form and Instruction
3 Informed Consent Informed Consent.docx	Form and Instruction
3 Informed Consent Informed Consent.docx	Form and Instruction
2 Screening Questions Screening Questions.docx	Form and Instruction
2 Screening Questions Screening Questions.docx	Form and Instruction
05092023 - Fast Track Memo - Generic Clearance - OMB 0915-0212 - 020620235007.docx Fast Track Memo	IC Document
05092023 - Fast Track Memo - Generic Clearance - OMB 0915-0212 - 020620235007.docx Fast Track Memo	IC Document

IC Title:

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

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	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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54

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	54	54
Annual IC Time Burden (Hours)	95	95
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.