Patients 9-13 Focus Group

Improving Sickle Cell Transitions of Care through Health Information Technology Phase 1

Documents and Forms

Document Name Document Type
Form Form #6 Patients 9-13 Focus Group Form and Instruction
Form #6 Moderator Guide and Respondent Materials for Patients Ag Attachment 1 - Moderator Guide & Respondent Materials for Patients Ages 9-13.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Patients 9-13 Focus Group	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 and Instruction	Form #6	Moderator Guide and Respondent Materials for Patients Ages 9-13	Attachment 1 - Moderator Guide & Respondent Materials for Patients Ages 9-13.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	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	10	10
Annual IC Time Burden (Hours)	20	20
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.