Information Collection

Focus Group Eligibility Screener Category 2

IC 223244 under ICR 201608-0920-016 · OMB 0920-1172.

Documents and Forms

Document Name Document Type
Focus Group Eligibility Screener Category 2 Form
Focus Group Eligibility Screener Category 2 Att3d FG EligibScreenCat2.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Focus Group Eligibility Screener Category 2	Agency IC Tracking Number:

Is this a Common Form? No		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	none	Focus Group Eligibility Screener Category 2	Att3d FG EligibScreenCat2.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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