Information Collection

[NCIPC] Screening Survey for focus groups and interviews

IC 264563 under ICR 202506-0920-010 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1154-24CC [NCIPC] Screening Survey for focus groups and interviews	Form
Form 0920-1154-24CC Recruitment Materials - Focus Groups and Interviews - AI/AN Adults [NCIPC] Screening Survey for focus groups and interviews	Form
Form 0920-1154 (24CC) Focus Group Guide AI/AN Adults [NCIPC] Screening Survey for focus groups and interviews	Form and Instruction
Form 0920-1154 (24CC) Interview Guide Tribal Health Care Providers (HCPs) and Tribal Leaders [NCIPC] Screening Survey for focus groups and interviews	Form and Instruction
ATT 2 Focus Group Email 01.09.24 post NCIPC OMB review.docx	Instruction
ATT 2 Focus Group Email 01.09.24 post NCIPC OMB review.docx	Instruction
ATT 3 Focus Group follow up Email 01.09.24 post NCIPC OMB review.docx	Instruction
ATT 3 Focus Group follow up Email 01.09.24 post NCIPC OMB review.docx	Instruction
ATT 4 _Interviews Tribal HCPs EMAIL.docx	Instruction
ATT 4 _Interviews Tribal HCPs EMAIL.docx	Instruction
ATT 5 _Interviews Tribal HCPs FOLLOW UP EMAIL.docx	Instruction
ATT 5 _Interviews Tribal HCPs FOLLOW UP EMAIL.docx	Instruction
ATT 6 Interviews Tribal Leaders EMAIL.docx	Instruction
ATT 6 Interviews Tribal Leaders EMAIL.docx	Instruction
ATT 7 Interviews Tribal Leaders FOLLOW UP EMAIL.docx	Instruction
ATT 7 Interviews Tribal Leaders FOLLOW UP EMAIL.docx	Instruction
0920-1154-24CC Recruitment Materials - Focus Groups and Interviews - AI ATT 1 Screener - Focus Groups and Interviews 01.09.24 post NCIPC OMB review.docx	Form
0920-1154-24CC Recruitment Materials - Focus Groups and Interviews - AI ATT 1 Screener - Focus Groups and Interviews 01.09.24 post NCIPC OMB review.docx	Form
0920-1154 (24CC) Focus Group Guide AI/AN Adults ATT 8 Focus Group Guide - AIAN Adults.docx	Form and Instruction
0920-1154 (24CC) Focus Group Guide AI/AN Adults ATT 8 Focus Group Guide - AIAN Adults.docx	Form and Instruction
0920-1154 (24CC) Interview Guide Tribal Health Care Providers (HCPs) and ATT 9 Interview Guide - Tribal HCPs and Tribal Leaders.docx	Form and Instruction
0920-1154 (24CC) Interview Guide Tribal Health Care Providers (HCPs) and ATT 9 Interview Guide - Tribal HCPs and Tribal Leaders.docx	Form and Instruction
Supporting Statement B_ AI_AN Discharge Instructions_01.09.24_post NCIPC OMB review.docx SSB (24CC)	IC Document
Supporting Statement B_ AI_AN Discharge Instructions_01.09.24_post NCIPC OMB review.docx SSB (24CC)	IC Document
ATT 11 Privacy Act-Determination-signed by ISSO.pdf NCIPC OMB PII and Privacy Act Determination	IC Document
ATT 11 Privacy Act-Determination-signed by ISSO.pdf NCIPC OMB PII and Privacy Act Determination	IC Document
GEN IC Request memo_Discharge AI AN.docx Memo GenIC Clearance (24CC)	IC Document
GEN IC Request memo_Discharge AI AN.docx Memo GenIC Clearance (24CC)	IC Document
Supporting Statement A_ AI_AN Discharge Intructions_01.10.24.docx Support Statement A_AI_AN Discharge Instructions_01.10.24	IC Document
Supporting Statement A_ AI_AN Discharge Intructions_01.10.24.docx Support Statement A_AI_AN Discharge Instructions_01.10.24	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[NCIPC] Screening Survey for focus groups and interviews

Agency IC Tracking Number:

0920-1154-24CC

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-1154-24CC	No		Fillable Fileable
Instruction		No		Printable Only
Instruction		No		Printable Only
Instruction		No		Printable Only
Instruction		No		Printable Only
Instruction		No		Printable Only
Instruction		No		Printable Only
Form and Instruction	0920-1154 (24CC)	Yes	Yes	Paper Only
Form and Instruction	0920-1154 (24CC)	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 64

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	64	64
Annual IC Time Burden (Hours)	81	81
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSB (24CC)		01/22/2024
NCIPC OMB PII and Privacy Act Determination		01/22/2024
Memo GenIC Clearance (24CC)		01/26/2024
Support Statement A_AI_AN Discharge Instructions_01.10.24		01/29/2024

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].