View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Communities Putting Prevention to Work (CPPW) National Prevention Media Initiative Focus Group with Parents/Caregivers	Agency IC Tracking Number:

IC Status: Unchanged

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
Other-WORD			2013.05.30_Attachment 2 - Eligibility Screener.doc		No	No	Paper Only
Other-WORD			2013 05 30_Attachment 3 - Moderators Guide.docx		No	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	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	120	0	0	0	0	120
Annual IC Time Burden (Hours)	154	0	0	0	0	154
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
2013	2013.05.30_Attachment 1 - Research Plan - Burden Table.doc	06/24/2013
2013	2013.05.30_Attachment 4 - Consent Form.docx	06/24/2013
2013	2013.05.30_Attachment 5 - Materials.docx	06/24/2013
mini statement	2013.05.30_HMTS_Expedited_Form_CPPW_Focus_Groups[1].docx	07/03/2013

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