Information Collection

Family/Caregiver Focus Group Discussion

IC 267352 under ICR 202404-0906-009 · OMB 0906-0097.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0097 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Family/Caregiver Focus Group Discussion	Form and Instruction
2 Family-Caregiver Focus Group Discussion Attachment B2 - Family-Caregiver FGD_Final.docx	Form and Instruction
2 Family-Caregiver Focus Group Discussion Attachment B2 - Family-Caregiver FGD_Final.docx	Form and Instruction
Attachment B5 - Family-Caregiver FGD Consent_Final.docx Attachment B5 - Family-Caregiver FGD Consent_Final	IC Document
Attachment B5 - Family-Caregiver FGD Consent_Final.docx Attachment B5 - Family-Caregiver FGD Consent_Final	IC Document

IC Title:

Family/Caregiver Focus Group Discussion

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	2	Family-Caregiver Focus Group Discussion	Attachment B2 - Family-Caregiver FGD_Final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 42

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	42	42
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment B5 - Family-Caregiver FGD Consent_Final	Attachment B5 - Family-Caregiver FGD Consent_Final.docx	04/30/2024

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