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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Community Informants/Participants UCI
Agency IC Tracking Number:
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
1
instrument
5. Appendix C - Anonymous Demographic Questionnaire.doc
Yes
Yes
Paper Only
Form and Instruction
2
guide
7. Appendix E - Focus Group Moderator Guide.doc
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
100
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
100
0
100
0
0
0
Annual IC Time Burden (Hours)
170
0
170
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
1
1. Submission of Information Collection - UCI.doc
01/05/2009
2
2. UCI Formative Research Cover Memo.doc
01/05/2009
3
3. Appendix A - University of California-Irvine IRB Approval Memo.doc
01/05/2009
4
4. Appendix B - Summary of Methods and Segments.doc
01/05/2009
6
6. Appendix D - Study Information Sheet for Focus Groups.doc
01/05/2009
8
8. Appendix F - Study Information Sheet for Key Informant Interviews.doc
01/05/2009
Revised UCI Formative Research Cover Memo
2. UCI Formative Research Cover Memo.rev.doc
03/31/2009
Revised Appendix D - Study Information Sheet for Focus Groups
6. Appendix D - Study Information Sheet for Focus Groups.rev.doc
03/31/2009
Revised Appendix E - Focus Group Moderator Guide
7. Appendix E - Focus Group Moderator Guide.rev.doc
03/31/2009
Revised Appendix F - Study Information Sheet for Key Informant Interviews
8. Appendix F - Study Information Sheet for Key Informant Interviews.rev.doc
03/31/2009
Revised Appendix G - Recruitment Flyer for Focus Groups
9. Appendix G - Recruitment Flyer for Focus Groups.rev.doc
03/31/2009
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.