OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Survey (icl. informed consent and pre-collection questions)

IC 265150 under ICR 202411-0960-012 · OMB 0960-0836.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Attachment A-20. Pre-collection instrument.pdf Other- Pre-collection instrument
Attachment A-20. Pre-collection instrument.pdf Other- Pre-collection instrument
Attachment A-8. Exiter and Possible Exiter Survey (FINAL).docx Other-Beyond Benefits Study (BBS Sur
Attachment A-8. Exiter and Possible Exiter Survey (FINAL).docx Other-Beyond Benefits Study (BBS Sur
Attachment A-9. Exiter and Possible Exiter IDI Letter and Consent.pdf Other-Exiter and Possible Exiter IDI
Attachment A-9. Exiter and Possible Exiter IDI Letter and Consent.pdf Other-Exiter and Possible Exiter IDI
Attachment A-11. Exiter and Possible Exiter Focus Group Letter and Consent.pdf Other-Exiter and Possible Exiter Foc
Attachment A-11. Exiter and Possible Exiter Focus Group Letter and Consent.pdf Other-Exiter and Possible Exiter Foc
Attachment A-13. Service Provider Focus Group Letter and Consent.pdf Other- Service Provider Focus Group
Attachment A-13. Service Provider Focus Group Letter and Consent.pdf Other- Service Provider Focus Group
Attachment A-14. State Agency Leadership IDI Letter and Consent.pdf Other-State Agency Leadership IDI Le
Attachment A-14. State Agency Leadership IDI Letter and Consent.pdf Other-State Agency Leadership IDI Le
Attachment A-15. MI Practitioner Focus Group Consent.pdf Other- MI Practitioner Focus Group C
Attachment A-15. MI Practitioner Focus Group Consent.pdf Other- MI Practitioner Focus Group C
Attachment A-16. Exiter and Possible Exiter Survey Letter and Consent.pdf Other- Exiter and Possible Exiter Su
Attachment A-16. Exiter and Possible Exiter Survey Letter and Consent.pdf Other- Exiter and Possible Exiter Su

Information Collection (IC) Details

View Information Collection (IC)

layout table

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
Other- Pre-collection instrument No   Paper Only
Other-Beyond Benefits Study (BBS Survey) No   Paper Only
Other-Exiter and Possible Exiter IDI Letter and Consent No   Paper Only
Other-Exiter and Possible Exiter Focus Group Letter and Consent No   Paper Only
Other- Service Provider Focus Group Letter and Consent No   Paper Only
Other-State Agency Leadership IDI Letter and Consent. No   Paper Only
Other- MI Practitioner Focus Group Consent. No   Paper Only
Other- Exiter and Possible Exiter Survey Letter and Consent No   Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved 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 4,000 0 0 0 0 4,000
Annual IC Time Burden (Hours) 3,333 0 0 0 0 3,333
Annual IC Cost Burden (Dollars) 0 0 0 0 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.
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