Information Collection

[NCEZID] Focus Groups with Healthcare Providers on Endemic Mycoses

IC 264149 under ICR 202507-0920-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
[NCEZID] Focus Groups with Healthcare Providers on Endemic Mycoses	Form and Instruction
Focus Group Screener [NCEZID] Focus Groups with Healthcare Providers on Endemic Mycoses	Form and Instruction
Focus Group Consent Form [NCEZID] Focus Groups with Healthcare Providers on Endemic Mycoses	Form and Instruction
Focus Group Guide [NCEZID] Focus Groups with Healthcare Providers on Endemic Mycoses	Form and Instruction
Focus Group Screener Attachment 1_WS-CDC DFWED_Focus Group Screener_Endemic Mycoses_1.3.24_FINAL.docx	Form and Instruction
Focus Group Screener Attachment 1_WS-CDC DFWED_Focus Group Screener_Endemic Mycoses_1.3.24_FINAL.docx	Form and Instruction
Focus Group Consent Form Attachment 2_WS-CDC DFWED_Focus Group Consent Form_Endemic Mycoses_12.21.23_FINAL.docx	Form and Instruction
Focus Group Consent Form Attachment 2_WS-CDC DFWED_Focus Group Consent Form_Endemic Mycoses_12.21.23_FINAL.docx	Form and Instruction
Focus Group Guide Attachment 3_WS-CDC DFWED_Focus Group Guide_Endemic Mycoses_12.21.23_FINAL.docx	Form and Instruction
Focus Group Guide Attachment 3_WS-CDC DFWED_Focus Group Guide_Endemic Mycoses_12.21.23_FINAL.docx	Form and Instruction
WS-CDC DFWED_OMB Supporting Statement A_Endemic Mycoses_12.21.23_FINAL_final.docx SSA	IC Document
WS-CDC DFWED_OMB Supporting Statement A_Endemic Mycoses_12.21.23_FINAL_final.docx SSA	IC Document
WS-CDC DFWED_OMB Supporting Statement B_Endemic Mycoses_12.8.23_FINAL.docx SSB	IC Document
WS-CDC DFWED_OMB Supporting Statement B_Endemic Mycoses_12.8.23_FINAL.docx SSB	IC Document
Attachment 4-Human Subjects Determination.pdf Research Determination	IC Document
Attachment 4-Human Subjects Determination.pdf Research Determination	IC Document
WS-CDC DFWED_OMB GenIC Request_Endemic Mycoses_12.21.23_FINAL.docx GenIC Request Template	IC Document
WS-CDC DFWED_OMB GenIC Request_Endemic Mycoses_12.21.23_FINAL.docx GenIC Request Template	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[NCEZID] Focus Groups with Healthcare Providers on Endemic Mycoses

Agency IC Tracking Number:

0920-1154-24BW

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 and Instruction	n/a	Yes	No	Fillable Fileable
Form and Instruction	n/a	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 528

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	528	528
Annual IC Time Burden (Hours)	112	112
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA		01/10/2024
SSB		01/10/2024
Research Determination		01/10/2024
GenIC Request Template		01/10/2024

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

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