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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
2015 Focus Group Testing with General Public
Agency IC Tracking Number:
15ARO
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
none
Screener and Recruitment
Att B-1. Screening and Recruitment Form_English_6 22 2015.doc
Yes
No
Fillable Printable
Form and Instruction
none
Screener and Recruitment - Spanish
Att B-2. Screening and Recruitment Form_Spanish_6 22 2015.doc
Yes
No
Fillable Printable
Form and Instruction
none
Focus Group Guide
Att A-1. Focus Group Discussion Guide_English_6 22 2015.doc
Yes
No
Paper Only
Form and Instruction
none
Focus Group Guide - Spanish
Att A-2. Focus Group Discussion Guide_Spanish_6 22 2015.doc
Yes
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
756
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
756
0
756
0
0
0
Annual IC Time Burden (Hours)
529
0
529
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement A
SS A. 2015 Screen For Life _6 22 2015.doc
06/24/2015
Supporting Statement B
SS B. 2015 Screen for Life_6 22 2015.docx
06/24/2015
Consent
Att C-1. Consent Form English _6 22 2015.doc
06/24/2015
Consent - Spanish
Att C-2. Consent Form_Spanish_6 22 2015.docx
06/24/2015
Creative Concepts
Att D. Creative Concepts Brief_6 22 2015.doc
06/24/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.