Talk - Focus Group

Pretesting of Substance Abuse Prevention and Treatment and Mental Health Services Communications Messages

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0196 can be found here:

Documents and Forms

Document Name Document Type
Form Focus Group Protoc Talk - Focus Group Form and Instruction
Focus Group Protoc Focus Group Protocol Attachment A-Focus Group Protocol 12.7.15.docx Form and Instruction
Screener Screener Attachment B-Screening 12.7.15.docx Form and Instruction
Attachment C-Consent Form 12.7.15.docx Consent Form IC Document
Attachment D-Facilitator Guide 12.7.15.docx Facilitator Guide IC Document
SS-12.8.15.docx Supporting Statement IC Document
TransLet-4doc.doc Transmittal Letter IC Document
SS-12.8.15.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Talk - Focus Group	Agency IC Tracking Number:

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	Focus Group Protocol	Focus Group Protocol	Attachment A-Focus Group Protocol 12.7.15.docx		Yes	Yes	Fillable Fileable
Form and Instruction	Screener	Screener	Attachment B-Screening 12.7.15.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Consent Form	Attachment C-Consent Form 12.7.15.docx	12/08/2015
Facilitator Guide	Attachment D-Facilitator Guide 12.7.15.docx	12/08/2015
Supporting Statement	SS-12.8.15.docx	12/08/2015
Transmittal Letter	TransLet-4doc.doc	12/08/2015
Supporting Statement	SS-12.8.15.docx	12/08/2015

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