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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Focus Groups with the General Public to Test Understanding and Resonance of Temporomandibular Disorders Brochure (NIDCR)
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
Form and Instruction
1
Recruitment screener
Attachment 1_RecruitmentScreener_Updated (1).docx
No
Paper Only
Form and Instruction
2
Informed Consent Form
Attachment 2_Informed Consent Form (6).docx
No
Paper Only
Form and Instruction
3
homework instructions
Attachment 3_Homework Instructions (2).docx
No
Paper Only
Form and Instruction
4
Moderator's Guide
Attachment 5_Moderator's Guide (4).docx
No
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:
24
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
24
0
0
0
0
24
Annual IC Time Burden (Hours)
46
0
0
0
0
46
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Outreach Language
Attachment 4_Outreach Language (9).docx
05/20/2020
TMD brochure
Attachment 6_TMD Brochure.pdf
05/20/2020
Fast track template for TMD focus group
Fast Track Template_NIDCR-TMD-FINAL-5.20.20-UPDATED-CLEAN.docx
05/20/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.