Focus Groups about Alcohol Consumption during Pregnancy

Health Marketing

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0798 can be found here:

Documents and Forms

Document Name Document Type
Focus Groups about Alcohol Consumption during Pregnancy Form
Focus Group Guide Attachment 3.doc Form
Participant Questionnaire Attachment 4.doc Form
Screening Instrument Attachment 5.doc Form
Consent Form Attachment 6.doc Form
Attachment 1.pdf Authorizing Legislation IC Document
Attachment 2.pdf Authorizing Legislation IC Document
Attachment 7.doc Confirmation Letter IC Document
Attachment 8.pdf IRB Approval IC Document
Attachment 9.doc Recruitment Letter IC Document
Project 3 OMB ap Section A 10-22-09.final.doc Supporting Statement A IC Document

Information Collection (IC) Details

IC Title:	Focus Groups about Alcohol Consumption during Pregnancy	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	none	Focus Group Guide	Attachment 3.doc	No	No	Paper Only
Form	none	Participant Questionnaire	Attachment 4.doc	No	No	Paper Only
Form	none	Screening Instrument	Attachment 5.doc	No	No	Paper Only
Form	none	Consent Form	Attachment 6.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 480	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	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	480	0	0	0	0	0
Annual IC Time Burden (Hours)	317	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Authorizing Legislation	Attachment 1.pdf	10/05/2009
Authorizing Legislation	Attachment 2.pdf	10/05/2009
Confirmation Letter	Attachment 7.doc	10/05/2009
IRB Approval	Attachment 8.pdf	10/05/2009
Recruitment Letter	Attachment 9.doc	10/05/2009
Supporting Statement A	Project 3 OMB ap Section A 10-22-09.final.doc	10/26/2009

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