Educational Game Focus Group

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Educational Game Focus Group Form and Instruction
1 Screeners Attachment_1_Screener_3_25_15.docx Form and Instruction
2 Clinical Professional Consent Form and Script Attachment_2_Clinical Trial Professional Consent Script 3_25_15.doc Form and Instruction
3 Teacher Consent Form and Script Attachment_3_Teacher Consent Script 3_25_15.doc Form and Instruction
4 Parent Consent Form and Scriot Attachment_4_Parent Consent Script 3_25_15.doc Form and Instruction
5 Child Assent Form Attachment_5_Child Assent Script 3_25_15.doc Form and Instruction
Revised Fast Track submission Form 04_16_15.doc Fast Track Submission Form IC Document
Attachment 6 Invitation Letters for all Respondents 3_29_15.docx Focus Group Invitation Letter IC Document

Information Collection (IC) Details

IC Title:	Educational Game 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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Screeners	Attachment_1_Screener_3_25_15.docx	Yes	Yes	Printable Only
Form and Instruction	2	Clinical Professional Consent Form and Script	Attachment_2_Clinical Trial Professional Consent Script 3_25_15.doc	Yes	Yes	Fillable Fileable
Form and Instruction	3	Teacher Consent Form and Script	Attachment_3_Teacher Consent Script 3_25_15.doc	Yes	Yes	Fillable Fileable
Form and Instruction	4	Parent Consent Form and Scriot	Attachment_4_Parent Consent Script 3_25_15.doc	Yes	Yes	Fillable Fileable
Form and Instruction	5	Child Assent Form	Attachment_5_Child Assent Script 3_25_15.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 32	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	32	32
Annual IC Time Burden (Hours)	32	32
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Submission Form	Revised Fast Track submission Form 04_16_15.doc	04/17/2015
Focus Group Invitation Letter	Attachment 6 Invitation Letters for all Respondents 3_29_15.docx	04/17/2015

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