[NCIPC] Screening Survey for focus groups and interviews

[OS] CDC/ATSDR Formative Research and Tool Development

OMB: 0920-1154

IC ID: 264563

Documents and Forms
Document Name
Document Type
Form
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Form
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

[NCIPC] Screening Survey for focus groups and interviews 0920-1154-24CC
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-1154-24CC Recruitment Materials - Focus Groups and Interviews - AI/AN Adults ATT 1 Screener - Focus Groups and Interviews 01.09.24 post NCIPC OMB review.docx No   Fillable Fileable
Instruction ATT 2 Focus Group Email 01.09.24 post NCIPC OMB review.docx No   Printable Only
Instruction ATT 3 Focus Group follow up Email 01.09.24 post NCIPC OMB review.docx No   Printable Only
Instruction ATT 4 _Interviews Tribal HCPs EMAIL.docx No   Printable Only
Instruction ATT 5 _Interviews Tribal HCPs FOLLOW UP EMAIL.docx No   Printable Only
Instruction ATT 6 Interviews Tribal Leaders EMAIL.docx No   Printable Only
Instruction ATT 7 Interviews Tribal Leaders FOLLOW UP EMAIL.docx No   Printable Only
Form and Instruction 0920-1154 (24CC) Focus Group Guide AI/AN Adults ATT 8 Focus Group Guide - AIAN Adults.docx Yes Yes Paper Only
Form and Instruction 0920-1154 (24CC) Interview Guide Tribal Health Care Providers (HCPs) and Tribal Leaders ATT 9 Interview Guide - Tribal HCPs and Tribal Leaders.docx No   Paper Only

Health Public Health Monitoring

 

64 0
   
Individuals or Households
 
   100 %

  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 64 0 0 0 0 64
Annual IC Time Burden (Hours) 81 0 0 0 0 81
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSB (24CC) Supporting Statement B_ AI_AN Discharge Instructions_01.09.24_post NCIPC OMB review.docx 01/22/2024
NCIPC OMB PII and Privacy Act Determination ATT 11 Privacy Act-Determination-signed by ISSO.pdf 01/22/2024
Memo GenIC Clearance (24CC) GEN IC Request memo_Discharge AI AN.docx 01/26/2024
Support Statement A_AI_AN Discharge Instructions_01.10.24 Supporting Statement A_ AI_AN Discharge Intructions_01.10.24.docx 01/29/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
© 2025 OMB.report | Privacy Policy