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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Virtual Focus Groups with Primary Care Physicians and OBGYNs
Agency IC Tracking Number:
0920-0840-20CL
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
0920-0840
Recruitment Screener
Attachment 3 - Recruitment Screener 080119.docx
No
Printable Only
Other-WORD
Attachment 4 - Consent Form 082119.docx
No
Printable Only
Form
0920-0840
DISCUSSION GUIDE: Virtual Focus Groups with Primary Care Physicians and OBGYNs: Attitudes about Proposed Hepatitis C Screening Guidelines DVH 2019
Attachment 7 - Discussion Guide 080119.docx
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:
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
528
0
528
0
0
0
Annual IC Time Burden (Hours)
233
0
233
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.docx
11/20/2019
Supporting Statement B
SS B 082119.docx
11/14/2019
Att 1_Autho Leg
Attachment 1 - Authorizing Legislation 080119.docx
11/14/2019
Att 2_Initial Recruitment Email
Attachment 2 - Initial Recruitment Email 080119.docx
11/14/2019
Att 5_Focus Group Participation Confirmation
Attachment 5 - Focus Group Participation Confirmation Letter 080119.docx
11/14/2019
Att 6_ Focus Group Recruitment Spreadsheet
Attachment 6 - Focus Group Recruitment Spreadsheet 080119.docx
11/14/2019
Att 8_IRB Approval
Attachment 8 - IRB Approval Certification.pdf
11/14/2019
Att 9_Data Management Plan
Attachment 9_DataManagementPlan.docx
11/14/2019
Att 10_PIA
Attachment 10_PIA_1019.pdf
11/14/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.