Information Collection

Focus Group Participant Characteristics Form

IC 269570 under ICR 202407-0906-008 · OMB 0906-0098.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0098 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 9 Focus Group Participant Characteristics Form	Form and Instruction
9 Focus Group Participant Characteristics Form Instrument 9- MCHB- ADAPT HV Informal Contacts- 6.10.24.docx	Form and Instruction
9 Focus Group Participant Characteristics Form Instrument 9- MCHB- ADAPT HV Informal Contacts- 6.10.24.docx	Form and Instruction
9 0906-0098 9_Focus Group Participant Characteristics Form 0906-0098 9_Focus Group Participant Characteristics Form-All Phases.docx	Form and Instruction
9 0906-0098 9_Focus Group Participant Characteristics Form 0906-0098 9_Focus Group Participant Characteristics Form-All Phases.docx	Form and Instruction

IC Title:

Focus Group Participant Characteristics Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	9	Focus Group Participant Characteristics Form	Instrument 9- MCHB- ADAPT HV Informal Contacts- 6.10.24.docx		Yes	Yes	Fillable Fileable
Form and Instruction	9	0906-0098 9_Focus Group Participant Characteristics Form-All Phases (Redline 07302024)	0906-0098 9_Focus Group Participant Characteristics Form-All Phases.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

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	Previously Approved
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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